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CYSTIC FIBROSIS SERVICES, LLC
DSH140275 GENESIS MEDICAL CENTER - SILVIS
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Covered Entity Details
Entity Name
GENESIS MEDICAL CENTER - SILVIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140275
Entity Address
801 Illini Drive
Silvis, IL 61282
Medicare Provider Number
140275
Participating Start Date
1/1/2019
Last Recertification Date
8/14/2023
Entity Termination Date
1/1/2024
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
11/8/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Rogers, CFO
(563) 421-6513
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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