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CYSTIC FIBROSIS SERVICES, LLC
DSH150113 COMMUNITY HOSPITAL ANDERSON
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Covered Entity Details
Entity Name
COMMUNITY HOSPITAL ANDERSON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH150113
Entity Address
1515 NORTH MADISON AVE
ANDERSON, IN 46011
Medicare Provider Number
150113
Participating Start Date
4/1/2021
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
Beth Tharp, SVP/President of Hospital Services
(765) 298-5125
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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