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CYSTIC FIBROSIS SERVICES, LLC
DSH140113 OSF Heart of Mary Medical Center
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Covered Entity Details
Entity Name
OSF Heart of Mary Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140113
Entity Address
1400 WEST PARK STREET
URBANA, IL 61801
Medicare Provider Number
140113
Participating Start Date
10/1/2015
Last Recertification Date
9/3/2024
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
7/9/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Deborah Schimerowski, Regional CFO
(815) 725-7133 Ext: 7667
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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