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CYSTIC FIBROSIS SERVICES, LLC
DSH340023 ADVENTHEALTH HENDERSONVILLE
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Covered Entity Details
Entity Name
ADVENTHEALTH HENDERSONVILLE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340023
Entity Address
100 HOSPITAL DRIVE
HENDERSONVILLE, NC 28792
Medicare Provider Number
340023
Participating Start Date
4/1/2025
Last Recertification Date
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
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ella Stenstrom, CFO
(828) 681-2102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2019
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