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CYSTIC FIBROSIS SERVICES, LLC
CAH281359-00 MEMORIAL COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH281359-00
Entity Address
810 N. 22ND ST
BLAIR, NE 68008
Medicare Provider Number
281359
Participating Start Date
1/1/2011
Last Recertification Date
8/14/2024
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
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TIM SCHNACK, CHIEF FINANCIAL OFFICER
(402) 426-2182
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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