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CYSTIC FIBROSIS SERVICES, LLC
RRC100137-00 AdventHealth Heart of Florida
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Covered Entity Details
Entity Name
AdventHealth Heart of Florida
Subdivision Name
Type
Rural Referral Center
340B ID
RRC100137-00
Entity Address
40100 US HIGHWAY 27
DAVENPORT, FL 33837
Medicare Provider Number
100137
Participating Start Date
7/1/2020
Last Recertification Date
8/23/2024
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
1/11/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kami Mitchell Harmeling, Assistant Chief Financial Officer
(863) 419-1830
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/11/2023
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