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CYSTIC FIBROSIS SERVICES, LLC
SCH450370-00 COLUMBUS COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
COLUMBUS COMMUNITY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH450370-00
Entity Address
110 SHULT DRIVE
COLUMBUS, TX 78934
Medicare Provider Number
450370
Participating Start Date
1/1/2015
Last Recertification Date
8/22/2024
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
Contacts
Covered Entity Signing Official
James Vanek, CEO
(979) 493-7561
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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