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CYSTIC FIBROSIS SERVICES, LLC
DSH110191 PIEDMONT HENRY HOSPITAL INC.
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Covered Entity Details
Entity Name
PIEDMONT HENRY HOSPITAL INC.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH110191
Entity Address
1133 EAGLES LANDING PARKWAY
STOCKBRIDGE, GA 30281
Medicare Provider Number
110191
Participating Start Date
4/1/2023
Last Recertification Date
8/12/2024
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
6/29/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/8/2018
Contacts
Covered Entity Signing Official
Wesley James, CFO
(678) 604-1001
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/29/2017
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