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CYSTIC FIBROSIS SERVICES, LLC
RRC250141-00 BAPTIST MEM HOSPITAL DESOTO
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Covered Entity Details
Entity Name
BAPTIST MEM HOSPITAL DESOTO
Subdivision Name
Type
Rural Referral Center
340B ID
RRC250141-00
Entity Address
7601 SOUTHCREST
SOUTHAVEN, MS 38671
Medicare Provider Number
250141
Participating Start Date
11/12/2020
Last Recertification Date
8/28/2024
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
4/19/2021
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
4/19/2021
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