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CYSTIC FIBROSIS SERVICES, LLC
DSH010065 RUSSELL MEDICAL CENTER
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Covered Entity Details
Entity Name
RUSSELL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH010065
Entity Address
3316 Highway 280
ALEXANDER CITY, AL 35010
Medicare Provider Number
010065
Participating Start Date
1/1/2008
Last Recertification Date
9/8/2024
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
L.E. Peace III, CEO
(256) 329-7188
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/17/2018
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