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CYSTIC FIBROSIS SERVICES, LLC
DSH220074 SOUTHCOAST HOSPITALS GROUP, INC
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Covered Entity Details
Entity Name
SOUTHCOAST HOSPITALS GROUP, INC
Subdivision Name
DBA CHARLTON MEMORIAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH220074
Entity Address
363 HIGHLAND AVENUE
FALL RIVER, MA 02720
Medicare Provider Number
220074
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
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
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Renee Clark, Exec. Vice President & Chief Operating Officer
(508) 973-5872
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/15/2020
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