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CYSTIC FIBROSIS SERVICES, LLC
DSH040017A NORTH ARKANSAS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
NORTH ARKANSAS REGIONAL MEDICAL CENTER
Subdivision Name
CLAUDE PARRISH COMMUNITY HEALTH CLINIC
Type
Disproportionate Share Hospital
340B ID
DSH040017A
Entity Address
131 EAST HIGHWAY 14
LEAD HILL, AR 72644
Medicare Provider Number
040017
Outpatient Facility Provider Number
Participating Start Date
10/1/2010
Last Recertification Date
8/15/2023
Entity Termination Date
4/1/2024
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
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sammie Cribbs, Chief Executive Officer
(870) 414-5159
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2022
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