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CYSTIC FIBROSIS SERVICES, LLC
SCH340042-00 Onslow Memorial Hospital
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Covered Entity Details
Entity Name
Onslow Memorial Hospital
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH340042-00
Entity Address
317 Western Boulevard
Jacksonville, NC 28546
Medicare Provider Number
340042
Participating Start Date
7/1/2013
Last Recertification Date
8/19/2024
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
1/16/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Penney Burlingame Deal, President and CEO
(910) 577-4767
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/16/2019
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