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CYSTIC FIBROSIS SERVICES, LLC
RRC140179-00 OSF LITTLE COMPANY OF MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
OSF LITTLE COMPANY OF MARY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140179-00
Entity Address
2800 WEST 95TH STREET
EVERGREEN PARK, IL 60805
Medicare Provider Number
140179
Participating Start Date
1/1/2019
Last Recertification Date
8/30/2021
Entity Termination Date
10/1/2021
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
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Veronica Cordova, Director of Finance
(708) 229-5103
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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