Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
CAH251322-00 LAIRD HOSPITAL, INC.

Covered Entity Details

Entity Name

LAIRD HOSPITAL, INC.

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH251322-00

Entity Address

25117 HWY 15 BYPASS
UNION, MS 39365

Medicare Provider Number

251322

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

1/7/2019

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

1/7/2019

340B Drug Pricing Program Database