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CYSTIC FIBROSIS SERVICES, LLC
DSH440048 BAPTIST MEM HOSPITAL MEMPHIS
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL MEMPHIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH440048
Entity Address
6019 WALNUT GROVE ROAD
MEMPHIS, TN 38120
Medicare Provider Number
440048
Participating Start Date
7/1/2017
Last Recertification Date
8/26/2024
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
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kimberly Young, Vice President-Finance Operations
(901) 227-4080
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/14/2021
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