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CYSTIC FIBROSIS SERVICES, LLC
DSH450010 UNITED REGIONAL HEALTH CARE SYSTEM
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Covered Entity Details
Entity Name
UNITED REGIONAL HEALTH CARE SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450010
Entity Address
1600 ELEVENTH STREET
WICHITA FALLS, TX 76301
Medicare Provider Number
450010
Participating Start Date
1/1/2023
Last Recertification Date
8/23/2024
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
10/24/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert M. Pert, Chief Financial Officer
(940) 764-3023
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/10/2022
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