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CYSTIC FIBROSIS SERVICES
CAH141323-00 MASSAC COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MASSAC COUNTY HOSPITAL DISTRICT
Subdivision Name
Massac Memorial Hospital
Type
Critical Access Hospital
340B ID
CAH141323-00
Entity Address
28 CHICK ST.
METROPOLIS, IL 62960
Medicare Provider Number
141323
Participating Start Date
8/31/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES
Pharmacy Address
CYSTIC FIBROSIS SERVICES, INC
10530 JOHN W ELLIOTT DR, STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
10/19/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/9/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Randall Rushing, Chief Financial Officer
(618) 524-2176 Ext: 257
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/19/2016
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