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CYSTIC FIBROSIS SERVICES, LLC
CAH371334-00 CARNEGIE TRI-COUNTY MUNICIPAL HOSPIT
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Covered Entity Details
Entity Name
CARNEGIE TRI-COUNTY MUNICIPAL HOSPIT
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH371334-00
Entity Address
102 N BROADWAY
CARNEGIE, OK 73015
Medicare Provider Number
371334
Participating Start Date
1/1/2020
Last Recertification Date
8/16/2024
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
10/9/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael W Hand, CFO
(316) 218-3350
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/9/2018
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