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CYSTIC FIBROSIS SERVICES, LLC
DSH220010 LAWRENCE GENERAL HOSPITAL
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Covered Entity Details
Entity Name
LAWRENCE GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220010
Entity Address
1 GENERAL STREET
LAWRENCE, MA 01841
Medicare Provider Number
220010
Participating Start Date
7/1/2004
Last Recertification Date
8/21/2024
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
10/8/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Deborah J. Wilson, CFO
(978) 683-4000 Ext: 2004
Contract Pharmacy Representative
Lawrence General Hospital
Timothy Keaney, Pharmacy Director
(978) 683-4000 Ext: 2247
Signed By Date
10/8/2020
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