Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
RWI606401A UI Health Community Clinic Network

Covered Entity Details

Entity Name

UI Health Community Clinic Network

Subdivision Name

West Side (Austin)

Type

Ryan White Part A

340B ID

RWI606401A

Entity Address

5225 W Madison
Chicago, IL 60644

Grant Number

H89HA00008

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

340B Drug Pricing Program Database