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CYSTIC FIBROSIS SERVICES, LLC
CAH141340-00 VALLEY WEST COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
VALLEY WEST COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141340-00
Entity Address
1302 N. MAIN STREET
SANDWICH, IL 60548
Medicare Provider Number
141340
Participating Start Date
7/1/2017
Last Recertification Date
8/26/2024
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
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Kokott, VP, Operations
(815) 766-9052
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/14/2020
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