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CYSTIC FIBROSIS SERVICES, LLC
DSH100132 SOUTH FLORIDA BAPTIST HOSPITAL
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Covered Entity Details
Entity Name
SOUTH FLORIDA BAPTIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100132
Entity Address
3202 N Park Rd
PLANT CITY, FL 33563
Medicare Provider Number
100132
Participating Start Date
1/1/2004
Last Recertification Date
8/26/2024
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
6/30/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carl Tremonti, Chief Financial Officer
(813) 870-4020
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/30/2017
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