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CYSTIC FIBROSIS SERVICES, LLC
DSH340151 Halifax Regional Medical Center, Inc. d/b/a ECU Health North Hospital
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Covered Entity Details
Entity Name
Halifax Regional Medical Center, Inc. d/b/a ECU Health North Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH340151
Entity Address
250 SMITH CHURCH ROAD
ROANOKE RAPIDS, NC 27870
Medicare Provider Number
340151
Participating Start Date
7/1/2004
Last Recertification Date
8/22/2024
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
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jason Harrell, President
(252) 535-8115
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/13/2023
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