Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
RRC450032-00 GOOD SHEPHERD MEDICAL CENTER

Covered Entity Details

Entity Name

GOOD SHEPHERD MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC450032-00

Entity Address

811 SOUTH WASHINGTON
MARSHALL, TX 75670

Medicare Provider Number

450032

Participating Start Date

11/30/2020

Last Recertification Date

8/18/2021

Entity Termination Date

7/1/2022

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

11/3/2020

Contract Begin Date

12/2/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/28/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Michael Cheek, CFO
(903) 315-1814

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/9/2020

340B Drug Pricing Program Database