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CYSTIC FIBROSIS SERVICES, LLC
HV616561C UI Health Community Clinic Network
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Covered Entity Details
Entity Name
UI Health Community Clinic Network
Subdivision Name
Southeast (South Chicago)
Type
Ryan White Part C
340B ID
HV616561C
Entity Address
8910 S Commercial Ave
Chicago, IL 60636
Grant Number
H76HA00686
Participating Start Date
10/1/2019
Last Recertification Date
2/19/2025
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
4/10/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard M. Novak, Chief, Division of Infectious Diseases/Ryan White Part A and C Project Director
(312) 996-6763
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2020
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