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CYSTIC FIBROSIS SERVICES, LLC
DSH130071 St. Luke's Nampa Medical Center
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Covered Entity Details
Entity Name
St. Luke's Nampa Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH130071
Entity Address
9850 W ST LUKES DRIVE
Nampa, ID 83687
Medicare Provider Number
130071
Participating Start Date
7/1/2019
Last Recertification Date
8/27/2024
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
7/16/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/16/2019
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