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CYSTIC FIBROSIS SERVICES, LLC
DSH230017 BRONSON METHODIST HOSPITAL
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Covered Entity Details
Entity Name
BRONSON METHODIST HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH230017
Entity Address
601 JOHN STREET
KALAMAZOO, MI 49007
Medicare Provider Number
230017
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
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
6/28/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James B. Falahee Jr., Sr. Vice President, Legal & Legislative Affairs
(269) 341-8907
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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