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CYSTIC FIBROSIS SERVICES, LLC
DSH230089 WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital
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Covered Entity Details
Entity Name
WILLIAM BEAUMONT HOSPITAL D/B/A Corewell Health Beaumont Grosse Pointe Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230089
Entity Address
468 CADIEUX ROAD
GROSSE POINTE, MI 48230
Medicare Provider Number
230089
Participating Start Date
1/1/2017
Last Recertification Date
8/21/2024
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
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carolyn Wilson, Chief Operating Officer
(947) 522-3338
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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