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CYSTIC FIBROSIS SERVICES, LLC
CAH511318-00 Montgomery General Hospital, Inc
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Covered Entity Details
Entity Name
Montgomery General Hospital, Inc
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH511318-00
Entity Address
401 Sixth Avenue
Montgomery, WV 25136
Medicare Provider Number
511318
Participating Start Date
7/1/2012
Last Recertification Date
8/16/2024
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
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sherri Murray, CFO
(304) 442-1246
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2018
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