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CYSTIC FIBROSIS SERVICES, LLC
DSH100039B BROWARD HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
BROWARD HEALTH MEDICAL CENTER
Subdivision Name
SEVENTH AVENUE FAMILY HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH100039B
Entity Address
200 NORTHWEST 7TH AVENUE
FT. LAUDERDALE, FL 33311
Medicare Provider Number
100039
Outpatient Facility Provider Number
Participating Start Date
7/1/2008
Last Recertification Date
8/19/2019
Entity Termination Date
10/1/2020
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
4/17/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/30/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alex Fernandez, CFO
(954) 355-5841
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/17/2018
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