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CYSTIC FIBROSIS SERVICES, LLC
DSH250067 CLAY COUNTY MEDICAL CORPORATION
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Covered Entity Details
Entity Name
CLAY COUNTY MEDICAL CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH250067
Entity Address
150 Medical Center Drive
WEST POINT, MS 39773
Medicare Provider Number
250067
Participating Start Date
4/1/2015
Last Recertification Date
9/10/2024
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
7/15/2020
Contract Begin Date
7/29/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BRUCE J. TOPPIN, GENERAL COUNSEL, PRIVACY OFFICER & COPORATE SECRETARY
(662) 377-4229
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2020
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