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CYSTIC FIBROSIS SERVICES, LLC
DSH140012 OSF Saint Katharine Medical Center
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Covered Entity Details
Entity Name
OSF Saint Katharine Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140012
Entity Address
403 EAST FIRST STREET
DIXON, IL 61021
Medicare Provider Number
140012
Participating Start Date
7/1/2024
Last Recertification Date
8/29/2024
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
6/30/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Anthony Evers, CFO
(815) 285-5521
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/30/2017
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