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CYSTIC FIBROSIS SERVICES, LLC
DSH180070 Owensboro Health Twin Lakes Regional Medical Center, Inc
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Covered Entity Details
Entity Name
Owensboro Health Twin Lakes Regional Medical Center, Inc
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180070
Entity Address
910 WALLACE AVENUE
LEITCHFIELD, KY 42754
Medicare Provider Number
180070
Participating Start Date
4/1/2006
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
7/18/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/8/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Wayne Meriwether, CEO
(270) 259-9510
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/18/2018
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