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CYSTIC FIBROSIS SERVICES, LLC
DSH160146 ST. LUKE'S REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. LUKE'S REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160146
Entity Address
2720 STONE PARK BLVD
SIOUX CITY, IA 51104
Medicare Provider Number
160146
Participating Start Date
1/1/2009
Last Recertification Date
8/12/2024
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
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James L. Gobell, CFO
(712) 279-3949
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/14/2021
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