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CYSTIC FIBROSIS SERVICES, LLC
DSH390028 UPMC MERCY
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Covered Entity Details
Entity Name
UPMC MERCY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390028
Entity Address
1400 LOCUST STREET
PITTSBURGH, PA 15219
Medicare Provider Number
390028
Participating Start Date
9/2/2008
Last Recertification Date
8/29/2024
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
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/19/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ron Wesley Deems, CFO Mercy and Magee
(412) 576-8808
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/12/2022
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