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CYSTIC FIBROSIS SERVICES, LLC
CAH151310-00 Parkview Wabash Hospital, Inc
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Covered Entity Details
Entity Name
Parkview Wabash Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH151310-00
Entity Address
10 John Kissinger Drive
WABASH, IN 46992-1914
Medicare Provider Number
151310
Participating Start Date
8/12/2010
Last Recertification Date
8/15/2024
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
6/28/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/21/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jeanne Wickens, CFO
(260) 373-8407
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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