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CYSTIC FIBROSIS SERVICES, LLC
DSH170122 Ascension Via Christi Hospitals Wichita, Inc
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Covered Entity Details
Entity Name
Ascension Via Christi Hospitals Wichita, Inc
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH170122
Entity Address
929 N. St. Francis
Wichita, KS 67214
Medicare Provider Number
170122
Participating Start Date
1/1/2012
Last Recertification Date
8/15/2024
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
1/5/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jim C Garrelts, Vice President, Pharmacy
(316) 268-5580
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/5/2021
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