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CYSTIC FIBROSIS SERVICES, LLC
RRC250102-00 MS BAPTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
MS BAPTIST MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC250102-00
Entity Address
1225 NORTH STATE ST.
JACKSON, MS 39202
Medicare Provider Number
250102
Participating Start Date
11/28/2022
Last Recertification Date
8/27/2024
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
1/3/2023
Contract Begin Date
4/1/2023
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
1/3/2023
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