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CYSTIC FIBROSIS SERVICES, LLC
DSH360211 TRINITY HOSPITAL HOLDING COMPANY
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Covered Entity Details
Entity Name
TRINITY HOSPITAL HOLDING COMPANY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH360211
Entity Address
4000 JOHNSON ROAD
STEUBENVILLE, OH 43952
Medicare Provider Number
360211
Participating Start Date
4/1/2022
Last Recertification Date
8/20/2024
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
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Dave Werkin, CFO
(740) 264-8695
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/12/2018
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