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CYSTIC FIBROSIS SERVICES, LLC
CAH251323-00 SCOTT REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
SCOTT REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH251323-00
Entity Address
317 HIGHWAY 13 SOUTH
MORTON, MS 39117
Medicare Provider Number
251323
Participating Start Date
1/1/2011
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
1/3/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Suzanne Mize, 340B Administrator
(205) 459-9180
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/3/2019
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