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CYSTIC FIBROSIS SERVICES, LLC
DSH250050 OKTIBBEHA COUNTY HOSPITAL
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Covered Entity Details
Entity Name
OKTIBBEHA COUNTY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250050
Entity Address
400 HOSPITAL ROAD
STARKVILLE, MS 39759-0000
Medicare Provider Number
250050
Participating Start Date
7/1/2006
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
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/13/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Susan H. Russell, Chief Financial officer
(662) 615-2550
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2018
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