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CYSTIC FIBROSIS SERVICES, LLC
RRC360070-00 CLEVELAND CLINIC MERCY HOSPITAL
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Covered Entity Details
Entity Name
CLEVELAND CLINIC MERCY HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC360070-00
Entity Address
1320 MERCY DRIVE N.W
CANTON, OH 44708
Medicare Provider Number
360070
Participating Start Date
7/1/2020
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
1/12/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David K Stewart, SVP / COO / CFO
(330) 489-1007
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/12/2021
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