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CYSTIC FIBROSIS SERVICES, LLC
DSH410007 RHODE ISLAND HOSPITAL
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Covered Entity Details
Entity Name
RHODE ISLAND HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH410007
Entity Address
593 EDDY STREET
PROVIDENCE, RI 02903
Medicare Provider Number
410007
Participating Start Date
4/1/2004
Last Recertification Date
8/19/2024
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
1/13/2021
Contract Begin Date
1/21/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Wakefield, Senior VP and CFO
(401) 444-7093
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/13/2021
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