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CYSTIC FIBROSIS SERVICES, LLC
DSH180048 EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
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Covered Entity Details
Entity Name
EPHRAIM MCDOWELL REGIONAL MEDICAL CENTER, INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH180048
Entity Address
217 SOUTH THIRD STREET
DANVILLE, KY 40422
Medicare Provider Number
180048
Participating Start Date
10/1/2004
Last Recertification Date
8/16/2024
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
4/10/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William M. SNAPP III, CFO
(859) 239-2424
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2019
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