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CYSTIC FIBROSIS SERVICES, LLC
PED363303-00 CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
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Covered Entity Details
Entity Name
CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON
Subdivision Name
Type
Children's Hospital
340B ID
PED363303-00
Entity Address
ONE PERKINS SQUARE
AKRON, OH 44308-1063
Medicare Provider Number
363303
Participating Start Date
2/26/2010
Last Recertification Date
8/30/2024
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
10/5/2021
Contract Begin Date
10/26/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alicia Lamancusa, Vice President Finance
(330) 543-8171
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/5/2021
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