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CYSTIC FIBROSIS SERVICES, LLC
DSH040051 Baptist Health Medical Center - Drew County
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Covered Entity Details
Entity Name
Baptist Health Medical Center - Drew County
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH040051
Entity Address
778 SCOGIN DRIVE
MONTICELLO, AR 71655
Medicare Provider Number
040051
Participating Start Date
7/1/2010
Last Recertification Date
9/4/2024
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
Contract Termination Date
Termination Reason
7/3/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Scott Barrilleaux, CEO
(870) 460-3589
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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