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CYSTIC FIBROSIS SERVICES, LLC
DSH050315 KERN MEDICAL CENTER
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Covered Entity Details
Entity Name
KERN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050315
Entity Address
1700 MT. VERNON AVE.
BAKERSFIELD, CA 93306
Medicare Provider Number
050315
Participating Start Date
10/1/1995
Last Recertification Date
8/13/2024
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
12/10/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Russell V Judd, Chief Executive Officer
(661) 326-2102
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
12/10/2017
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