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CYSTIC FIBROSIS SERVICES, LLC
DSH150074 Community Health Network, Inc.
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Covered Entity Details
Entity Name
Community Health Network, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150074
Entity Address
1500 N. RITTER AVE.
INDIANAPOLIS, IN 46219
Medicare Provider Number
150074
Participating Start Date
4/1/2008
Last Recertification Date
8/12/2024
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
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/3/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott L. Teffeteller, President, East Region
(317) 355-3390
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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