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CYSTIC FIBROSIS SERVICES, LLC
DSH410009 KENT COUNTY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
KENT COUNTY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH410009
Entity Address
455 TOLL GATE ROAD
WARWICK, RI 02886
Medicare Provider Number
410009
Participating Start Date
7/1/2015
Last Recertification Date
8/20/2024
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
10/3/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
James Burke, VP Finance
(401) 737-7010 Ext: 31154
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
6/28/2017
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