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CYSTIC FIBROSIS SERVICES, LLC
CAH171327-00 ELLSWORTH COUNTY MEDICAL CENTER
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Covered Entity Details
Entity Name
ELLSWORTH COUNTY MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH171327-00
Entity Address
1604 AYLWARD AVE.
ELLSWORTH, KS 67439
Medicare Provider Number
171327
Participating Start Date
8/6/2010
Last Recertification Date
9/3/2024
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
10/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Preston M Sauers, Director of Business Operations
(785) 472-3111 Ext: 320
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/8/2018
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