Contract Pharmacy Details

CYSTIC FIBROSIS SERVICES, LLC
DSH110229 Piedmont Newnan Hospital, Inc.

Covered Entity Details

Entity Name

Piedmont Newnan Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110229

Entity Address

745 Poplar Road
Newnan, GA 30265

Medicare Provider Number

110229

Participating Start Date

7/1/2013

Last Recertification Date

9/3/2019

Entity Termination Date

1/1/2020

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

7/7/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

John G. Miles, Vice President / CFO
(770) 400-2336

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/7/2017

340B Drug Pricing Program Database