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CYSTIC FIBROSIS SERVICES, LLC
RRC100086-00 BROWARD HEALTH NORTH
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Covered Entity Details
Entity Name
BROWARD HEALTH NORTH
Subdivision Name
Type
Rural Referral Center
340B ID
RRC100086-00
Entity Address
201 EAST SAMPLE ROAD
POMPANO BEACH, FL 33064
Medicare Provider Number
100086
Participating Start Date
1/1/2020
Last Recertification Date
9/13/2021
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
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joshua Szostek, CFO
(954) 786-4554
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/15/2020
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