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CYSTIC FIBROSIS SERVICES, LLC
CAH181309-00 CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
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Covered Entity Details
Entity Name
CASEY COUNTY HOSPITAL DISTRICT D/B/A CASEY COUNTY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH181309-00
Entity Address
187 WOLFORD AVENUE
LIBERTY, KY 42539
Medicare Provider Number
181309
Participating Start Date
7/1/2011
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
1/18/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/4/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
REX A. TUNGATE, CEO
(606) 787-6275 Ext: 601
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2018
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