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CYSTIC FIBROSIS SERVICES, LLC
DSH390178 UPMC HORIZON HOSPITAL
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Covered Entity Details
Entity Name
UPMC HORIZON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390178
Entity Address
110 NORTH MAIN STREET
GREENVILLE, PA 16125
Medicare Provider Number
390178
Participating Start Date
4/1/2017
Last Recertification Date
9/5/2024
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
7/13/2022
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
Michael Tracy, Jr., CFO
(724) 656-4107
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2022
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