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CYSTIC FIBROSIS SERVICES, LLC
SCH460007-00 IHC HEALTH SERVICES, INC. DBA: CEDAR CITY HOSPITAL
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Covered Entity Details
Entity Name
IHC HEALTH SERVICES, INC. DBA: CEDAR CITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH460007-00
Entity Address
1303 NORTH MAIN
CEDAR CITY, UT 84720
Medicare Provider Number
460007
Participating Start Date
10/1/2019
Last Recertification Date
Entity Termination Date
7/1/2020
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
8/5/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/3/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Craig Dale Corry, Finance Director
(435) 868-5819
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/11/2019
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