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CYSTIC FIBROSIS SERVICES, LLC
DSH050036 BAKERSFIELD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BAKERSFIELD MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050036
Entity Address
420 34TH STREET
BAKERSFIELD, CA 93301
Medicare Provider Number
050036
Participating Start Date
9/9/2005
Last Recertification Date
8/20/2024
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
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/10/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ken Keller, President
(661) 541-0001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2019
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