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CYSTIC FIBROSIS SERVICES, LLC
PED143300-00 Ann & Robert H. Lurie Children's Hospital of Chicago
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Covered Entity Details
Entity Name
Ann & Robert H. Lurie Children's Hospital of Chicago
Subdivision Name
Type
Children's Hospital
340B ID
PED143300-00
Entity Address
225 E. Chicago Ave.
Chicago, IL 60611-2605
Medicare Provider Number
143300
Participating Start Date
10/1/2011
Last Recertification Date
8/27/2024
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
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Stahulak, Chief Nursing Officer
(312) 227-4622
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/17/2023
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