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CYSTIC FIBROSIS SERVICES, LLC
DSH510007 ST. MARYS MEDICAL CENTER INC.
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Covered Entity Details
Entity Name
ST. MARYS MEDICAL CENTER INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH510007
Entity Address
2900 FIRST AVENUE
HUNTINGTON, WV 25702-1241
Medicare Provider Number
510007
Participating Start Date
7/1/2016
Last Recertification Date
9/5/2024
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
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/14/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Angela Swearingen, VP Finance/CFO
(304) 526-1224
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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