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CYSTIC FIBROSIS SERVICES, LLC
SCH140189-00 SARAH BUSH LINCOLN HEALTH CENTER
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Covered Entity Details
Entity Name
SARAH BUSH LINCOLN HEALTH CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140189-00
Entity Address
1000 HEALTH CENTER DRIVE
MATTOON, IL 61938
Medicare Provider Number
140189
Participating Start Date
7/1/2018
Last Recertification Date
9/4/2024
Entity Termination Date
4/1/2025
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
10/19/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Jerry Esker, President & CEO
(217) 258-2540
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/19/2020
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