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CYSTIC FIBROSIS SERVICES
CAH111306-00 EFFINGHAM HEALTH SYSTEM
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Covered Entity Details
Entity Name
EFFINGHAM HEALTH SYSTEM
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH111306-00
Entity Address
459 HIGHWAY 119 SOUTH
SPRINGFIELD, GA 31329-3021
Medicare Provider Number
111306
Participating Start Date
1/1/2011
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES
Pharmacy Address
CYSTIC FIBROSIS SERVICES, INC
10530 JOHN W ELLIOTT DR, STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
2/1/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/28/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Fran Baker-Witt, CEO
(912) 754-3822
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/1/2017
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