340B Drug Pricing Program Database


DSH220031 BOSTON MEDICAL CENTER (Active) - information as of 6/24/2025 12:01:55 AM

Main Details
BOSTON MEDICAL CENTER
Disproportionate Share Hospital
Yes
DSH220031
220031


Additional Details
Active
9/10/2007
12/1/1992
9/10/2007
8/21/2024

Contacts

Boston Medical Center
Alastair Bell, Chief Executive Officer
(617) 638-6718

Boston Medical Center
Noreen A. Palinkas, Director Pharmacy Compliance
(617) 638-5843

Addresses

1 Boston Medical Center Place
BOSTON, MA 02118

Boston Medical Center
850 Harrison Avenue
YACC Basement (Outpatient Pharmacy Offices)
BOSTON, MA 02118


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
2/24/10 UPDATED ADDR (WAS 850 HARRISON AVE) AND ADDED BILL TO; 1/19/10 UPDATED ADDR (WAS 818 HARRISON AVE AMBULATORY CARE CTR); 1/14/10 ADDED SHIP TO ADDR02/24/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MA110022129A,110092155F,110092155K,110092155N,110092155O,110022129B1366433104,1114918950,1346218294,1083952329,1083141659,1942819164,1740899244,1851005763,1073395836,1962279109
NH110092155N1083141659
Shipping Addresses

Boston Medical Center
750 Albany St
Menino Pavilion Loading Dock
Boston, MA 02118

Boston Medical Center
41 Teed Dr.
Cornerstone Health Solutions
Randolph, MA 02368

Boston Medical Center
818 Harrison Ave
Menino Pavilion 5 (Inpatient Pharmacy)
Boston, MA 02118

Boston Medical Center
850 Harrison Ave
Pharmacy
Boston, MA 02118

Boston Medical Center
818 Harrison Ave
Yawkey Ambulatory Care Center Level 1 (OP Pharmacy)
Boston, MA 02118

Boston Medical Center
720 Harrison Ave
Pharmacy
Boston, MA 02118

Safecor Health, LLC
317 New Boston Street
Suite 100
Woburn, MA 01801

Boston Medical Center
725 Albany St
Shapiro Pharmacy
Boston, MA 02118

Boston Medical Center Menino Pavilion
840 Harrison Ave., Basement
Boston, MA 02118

BMC Pharmacy at Codman Square
637 Washington St.
Pharmacy
Dorchester, MA 02124

Boston Medical Center Pharmacy at Manet
110 W. Squantum St.
Pharmacy
Quincy, MA 02171-2122

Boston Medical Center Outpatient Pharmacy - Preston Building
732 Harrison Ave.
Boston, MA 02118-2309

Boston Medical Center Pharmacy at Crosstown
801 Massachusetts Ave.
Boston, MA 02118

Boston Medical Center
Pharmacy @ South Boston
409 West Broadway
South Boston, MA 02127
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/08/201610/01/2016  07/08/2016
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/08/201610/01/2016  07/08/2016
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/10/201707/01/2017  04/10/2017
Contract DetailACCREDO HEALTH GROUP INC261 CEDAR HILL ST BUILDING C
MARLBOROUGHMA01752-305604/17/202307/01/2023  07/01/2023
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/08/201610/01/2016  07/08/2016
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/08/201610/01/2016  07/08/2016
Contract DetailACCREDO HEALTH GROUP, INC.  PHARMACY
2 BOULDEN CIRCLE SUITE 1 		NEW CASTLEDE1972007/08/201610/01/2016  07/08/2016
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/17/202307/01/2023  07/01/2023
Contract DetailAMERICAN HOMECARE FEDERATION, INC.  95E ASHLEY AVENUE
WEST SPRINGFIELDMA0108901/22/201504/01/2015 03/31/201903/31/2019
Contract DetailATLAS PHARMAHEALTH, INC.DBA CROWN COLONY PHARMACY & CO. 500 CONGRESS ST STE 1B
QUINCYMA0216910/17/202301/01/2024 04/01/202504/15/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/08/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/08/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/08/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/08/202407/01/2024  07/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/08/202407/01/2024  07/01/2024
Contract DetailBRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410610/16/201701/01/2018 10/01/201910/29/2019
Contract DetailBRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET 		AVONMA0232210/16/201701/01/2018 10/01/201910/29/2019
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813301/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237401/20/201704/01/2017 03/31/201903/31/2019
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/20/202107/01/2021  07/01/2021
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/20/202107/01/2021  07/01/2021
Contract DetailCRAWFORD DRUG,LLC1735 DORCHESTER AVE
DORCHESTERMA0212410/17/202301/01/2024 04/01/202504/15/2025
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/20/202107/01/2021  07/01/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/20/202107/01/2021  07/01/2021
Contract DetailCVS PHARMACY INC150 INDUSTRIAL DR., WRHS #2
NORTH SMITHFIELDRI0289610/14/201401/01/2015 01/02/202301/17/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00471 778 DUDLEY ST.
DORCHESTERMA0212507/24/201310/01/2013  05/12/2016
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00720 2235 DORCHESTER AVENUE
BOSTONMA0212407/24/201310/01/2013  05/12/2016
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 01049 942A HYDE PARK AVENUE
HYDE PARKMA0213607/24/201310/01/2013  05/12/2016
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 01252 874 HARRISON AVE
BOSTONMA0211807/24/201310/01/2013 04/01/202204/21/2022
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 01265 210 BORDER STREET
EAST BOSTONMA0212807/24/201310/01/2013  05/12/2016
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 02592 468 BLUE HILL AVE
DORCHESTERMA0212107/24/201310/01/2013  05/12/2016
Contract DetailCVS PHARMACY, INC.CVS PHARMACY # 17059 36 FURLONG DR
REVEREMA0215110/04/201701/01/2018  10/04/2017
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00496 324 BROADWAY
CHELSEAMA0215010/04/201701/01/2018  10/04/2017
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00137 626 SOUTHERN ARTERY, RTE 3A
QUINCYMA0216910/04/201701/01/2018  10/04/2017
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00619 1150 SARATOGA STREET
EAST BOSTONMA0212810/04/201701/01/2018  10/04/2017
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 03307 400 TREMONT STREET
BOSTONMA0211604/21/202207/01/2022 07/18/202308/17/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 01876 900 COMMONWEALTH AVENUE
BOSTONMA0221510/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 02878 550 PLEASANT ST.
FALL RIVERMA0272110/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00789 136 ASHLEY BLVD.
NEW BEDFORDMA0274610/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA CVS/PHARMACY #11036 451 WASHINGTON STREET
DORCHESTERMA0212410/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 02283 715 MORRISSEY BOULEVARD
DORCHESTERMA0212210/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA CVS/PHARMACY # 5464 1575 BLUE HILL AVE
MATTAPANMA0212610/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00685 1145 KEMPTON STREET
NEW BEDFORDMA0274010/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 00746 171 NORTH MAIN STREET
RANDOLPHMA0236810/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 02070 467 CENTRE STREET
JAMAICA PLAINMA0213010/18/202201/01/2023  01/01/2023
Contract DetailCVS PHARMACY, INC.DBA: CVS/PHARMACY # 01259 231 MASSACHUSETTS AVENUE
BOSTONMA0211510/18/202201/01/2023  01/01/2023
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/20/202107/01/2021  07/01/2021
Contract DetailD.A.W., LLCEATON APOTHECARY #3060 427 TURNPIKE ST STE 5
CANTONMA02021-270910/15/201401/01/2015 10/31/201910/31/2019
Contract DetailD.A.W., LLC.EATON APOTHECARY #2160 637 WASHINGTON ST
FLOOR G 		DORCHESTERMA0212410/15/201401/01/2015 10/31/201910/31/2019
Contract DetailD.A.W., LLC.CVS/PHARMACY # 11272 409 W BROADWAY
SOUTH BOSTONMA0212710/15/201401/01/2015 10/31/201910/31/2019
Contract DetailD.A.W., LLC.EATON APOTHECARY 20 MAVERICK SQ.
EAST BOSTONMA0212810/15/201401/01/2015 10/31/201910/31/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268301/22/201504/01/2015 09/01/202209/26/2022
Contract DetailDIPLOMAT SPECIALTY PHARMACYG3320 BEECHER RD
FLINTMI48532-361401/22/201504/01/2015 03/31/201903/31/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY1370 BUSCH PKWY
BUFFALO GROVEIL60089-450501/22/201504/01/2015 03/31/201903/31/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY OF FT LAUDERDIPLOMAT SPECIALTY PHARMACY 15471 SW 12TH ST
STE 207 		SUNRISEFL3332601/22/201504/01/2015 03/31/201903/31/2019
Contract DetailDIPLOMAT SPECIALTY PHARMACY OF SOUTHERNDIPLOMAT SPECIALTY PHARMACY 1809 EXCISE AVENUE
SUITE 204-208 		ONTARIOCA9176101/22/201504/01/2015 03/31/201903/31/2019
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654104/08/202407/01/2024  07/01/2024
Contract DetailE BOSTON NEIGHBORHOOD HLTH CTATTN PHARMACY 10 GOVE ST
EAST BOSTONMA02128-192001/17/202304/01/2023  04/01/2023
Contract DetailEAST BOSTON NEIGHBORHOOD HEALTH CENTERMAVERICK PHARMACY 20 MAVERICK SQ
EAST BOSTONMA02128-233510/18/202201/01/2023  01/01/2023
Contract DetailLYNNFIELD DRUG INCDBA FREEDOM FERTILITY PHARMACY 374 MERRIMAC ST STE 100
NEWBURYPORTMA0195010/16/201701/01/2018 01/01/202109/26/2022
Contract DetailMAXIM PHARMACY1365 DORCHESTER AVE (1365-1377 DORCHESTER AVE)
DORCHESTERMA0212210/17/202301/01/2024 04/01/202504/15/2025
Contract DetailMONA PHARMACY CORP1349 COMMONWEALTH AVE
ALLSTONMA0213410/17/202301/01/2024 04/01/202504/15/2025
Contract DetailNEW ENGLAND HOME THERAPIES, INCDBA BIOSCRIP INFUSION SERVICES 337 TURNPIKE RD
SOUTHBOROUGHMA0177201/20/201604/01/2016 10/31/201903/30/2024
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 734 FOREST ST.
SUITE 300 		MARLBOROUGHMA01752-303204/15/202507/01/2025  04/15/2025
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 49 FREEWAY DR.
SUITE A 		CRANSTONRI02920-793504/15/202507/01/2025  04/15/2025
Contract DetailOPTION CARE ENTERPRISES, INC.OPTION CARE 870 N. ARLINGTON HEIGHTS RD
SUITE 101 		ITASCAIL6014304/15/202507/01/2025  04/15/2025
Contract DetailOPTION CARE ENTERPRISES, INC.D/B/A OPTION CARE 11403 BLUEGRASS PARKWAY
SUITE 400 		LOUISVILLEKY40299-239804/15/202507/01/2025  04/15/2025
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191310/16/201701/01/2018 10/01/202001/17/2023
Contract DetailOPTUM INFUSION SERVICES 551, LLC100 CORPORATE DR STE 111
WINDSORCT0609501/22/201504/01/2015 03/31/201903/31/2019
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705810/19/202001/01/2021  01/01/2021
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850701/21/202201/24/2022  01/24/2022
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713010/16/201701/01/2018  10/16/2017
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729810/16/201701/01/2018  10/16/2017
Contract DetailOPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621907/17/202010/01/2020 05/28/202107/20/2021
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110110/16/201701/01/2018  10/16/2017
Contract DetailOPTUM PHARMACY 707, INC4900 RIVERGRADE RD STE E110
IRWINDALECA91706-140110/19/202001/01/2021  01/01/2021
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/20/202110/01/2021  10/01/2021
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/17/202010/01/2020 08/31/202210/26/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/20/201704/01/2017 03/31/201903/31/2019
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/20/202107/01/2021  07/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2971 350 LONGWOOD AVE., STE B
BOSTONMA0211504/16/202007/01/2020  07/01/2020
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/20/202107/01/2021  07/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/20/202107/01/2021  07/01/2021
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/20/202107/01/2021  07/01/2021
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255004/08/202407/01/2024  07/01/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/08/202407/01/2024  07/01/2024
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301304/08/202407/01/2024  07/01/2024
Contract DetailSULLIVAN'S PHARMACY INC1 CORINTH ST
ROSLINDALEMA0213104/13/201507/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO INCWALGREENS SPECIALTY PHARMACY #15307 21 STANHOPE STREET #23
BOSTONMA0211610/14/201401/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO. INC.DBA STRAND, A WALGREENS PHARMACY #13806 533 COLUMBIA ROAD
DORCHESTERMA0212504/04/201607/01/2016 03/09/202003/12/2020
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01847 757 GALLIVAN BLVD STE 3
DORCHESTERMA0212210/14/201401/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03016 416 WARREN ST
ROXBURYMA0211910/14/201401/01/2015 01/15/202404/08/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03135 825 MORTON STREET
BOSTONMA0212610/14/201401/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04072 1890 COLUMBUS AVE
ROXBURYMA0211910/14/201401/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06072 1603 WASHINGTON ST
BOSTONMA0211810/14/201401/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06349 585 WASHINGTON ST
DORCHESTERMA02124-203210/14/201401/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06805 130 BOWDOIN ST
DORCHESTERMA02122-183710/14/201401/01/2015 11/05/201911/05/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 09538 2275 WASHINGTON ST
ROXBURYMA02119-321210/14/201401/01/2015 11/08/202210/17/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #15001 980 AMERICAN LEGION HWY
ROSLINDALEMA02131-470110/14/201401/01/2015  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04535 170 N MAIN STREET
RANDOLPHMA0236804/04/201607/01/2016  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05756 1 CENTRAL SQ
EAST BOSTONMA0212804/04/201607/01/2016  05/12/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03130 185 CENTRE STREET
MALDENMA0214810/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04403 418 QUINCY AVENUE
QUINCYMA0216910/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 10317 1035 TRUMAN HWY
BOSTONMA0213610/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07189 1630 TREMONT STREET
ROXBURYMA0212010/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02977 1101 MAIN STREET
BROCKTONMA0230110/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02933 841 BOYLSTON STREET
BOSTONMA0211610/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02716 21 JOYCE ST
LYNNMA0190210/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03496 317 FERRY ST
EVERETTMA0214910/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04923 1999 CENTRE ST
WEST ROXBURYMA0213210/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04404 771 CENTRE ST.
BROCKTONMA0230210/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03758 610 PLEASANT ST.
BROCKTONMA02301-251310/10/201601/01/2017  10/10/2016
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS #16237 75 AMORY STREET
SUITE 100 		BOSTONMA0211910/10/201601/01/2017 04/15/201904/15/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02759 550 ADAMS ST
SUITE 6 		QUINCYMA0216901/10/201704/01/2017  01/10/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03759 1010 BROADWAY
CHELSEAMA0215001/10/201704/01/2017  01/10/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #11831 324 HANCOCK STREET
QUINCYMA02171-225801/10/201704/01/2017  01/10/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05755 413 WASHINGTON STREET
STOUGHTONMA02072-421010/04/201701/01/2018  10/04/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03564 99 HARVARD ST.
BROOKLINEMA0244610/04/201701/01/2018  10/04/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 10824 430 BROADWAY
REVEREMA0215110/04/201701/01/2018  10/04/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 02760 343 BROADWAY
SOMERVILLEMA0214510/04/201701/01/2018 04/01/201905/06/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #18361 132 GRANITE ST
QUINCYMA0216904/05/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #17169 710 E BROADWAY
SOUTH BOSTONMA0212704/05/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #19437 1100 DORCHESTER AVE
DORCHESTERMA0212504/05/201907/01/2019  07/01/2019
Contract DetailWALGREEN EASTERN CO., INC.WALGREENS #19067 1329 HYDE PARK AVE
HYDE PARKMA0213604/05/201907/01/2019 11/09/202210/17/2023
Contract DetailWalgreens Central Fill #2140044 Cabot Blvd.
MansfieldMA0204804/17/202307/01/2023  07/01/2023
Contract DetailWALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528410/14/201401/01/2015 07/08/201505/12/2016
Contract DetailWALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904910/14/201401/01/2015 07/08/201505/12/2016
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/22/201504/01/2015  05/12/2016
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/22/201504/01/2015 10/01/202110/08/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/22/201504/01/2015  05/12/2016
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/22/201504/01/2015  05/12/2016
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH220031DChildDSHBOSTON MEDICAL CENTERSouth Boston Community Health Center409 W BROADWAYSOUTH BOSTONMAActive
DSH220031EChildDSHBOSTON MEDICAL CENTERGreater Roslindale Medical and Dental Center4199 WASHINGTON STREETROSLINDALEMAActive
DSH220031FChildDSHBOSTON MEDICAL CENTERBOSTON MEDICAL CENTER CORP/Dorchester Home Multi-Service Center1353 DORCHESTER AVEDORCHESTERMAActive
DSH220031GChildDSHBOSTON MEDICAL CENTERBOSTON MEDICAL CENTER CORP/Codman Square Health Center637 WASHINGTON STREETDORCHESTER CENTERMAActive
DSH220031HChildDSHBOSTON MEDICAL CENTERBOSTON MEDICAL CENTER CORP/East Boston Neighborhood Health Center20 MAVERICK SQ 1ST 2ND 3RD FLEAST BOSTONMAActive
DSH220031JChildDSHBOSTON MEDICAL CENTERBOSTON MEDICAL CENTER CORP / South Boston Community Health Center386 WEST BROADWAYSOUTH BOSTONMAActive
DSH220031KChildDSHBOSTON MEDICAL CENTERBoston Medical Center Family Medicine - Family Medicine7 Melnea Cass Blvd.BostonMAActive
DSH220031LChildDSHBOSTON MEDICAL CENTERBoston Medical Center at Crosstown - Sleep Lab801 Massachusetts Ave.BostonMAActive
DSH220031MChildDSHBOSTON MEDICAL CENTERBoston Medical Center at Crosstown - Primary Care801 Massachusetts Ave.BostonMAActive
DSH220031NChildDSHBOSTON MEDICAL CENTERSOUTH BOSTON COMMUNITY HEALTH CTR - South Boston CHC - Seaport505 CONGRESS STBOSTONMAActive
DSH220031PChildDSHBOSTON MEDICAL CENTERBOSTON MEDICAL CENTER - CROSSTOWN - Pediatrics801 MASSACHUSETTS AVENUEBOSTONMAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification8/17/2023 8:44:24 AM8/21/2024 7:47:54 AM8/21/2024 7:47 AM
AddressesShipping AddressInsertChange Request Boston Medical Center Pharmacy @ South Boston 409 West Broadway South Boston, MA 021274/9/2024 9:03 AM
Medicaid BillingNPI: NumberInsertChange Request 19622791094/9/2024 9:03 AM
Medicaid BillingNPI: StateInsertChange Request MA4/9/2024 9:03 AM
Medicaid BillingNPI: NumberDeleteChange Request1205473162 (MA) 10/26/2023 4:30 PM
Medicaid BillingNPI: NumberInsertChange Request 107339583610/26/2023 4:30 PM
Medicaid BillingNPI: StateInsertChange Request MA10/26/2023 4:30 PM
DetailsLast Recertification DateUpdateRecertification8/29/2022 10:17:40 AM8/17/2023 8:44:24 AM8/17/2023 8:44 AM
ContactsAuthorizing OfficialUpdateChange RequestWalsh, Kathleen E. Chief Executive Officer Boston Medical Center 6176386911Bell, Alastair Chief Executive Officer Boston Medical Center 61763867183/6/2023 7:05 AM
Medicaid BillingNPI: NumberInsertChange Request 18510057632/15/2023 4:12 PM
Medicaid BillingNPI: StateInsertChange Request MA2/15/2023 4:12 PM
AddressesShipping AddressInsertChange Request Boston Medical Center Pharmacy at Crosstown 801 Massachusetts Ave. Boston, MA 021181/19/2023 1:22 PM
AddressesShipping AddressDeleteChange RequestBoston Medical Center 88 East Newton Street Doctor's Office Building 1 (DOB Pharmacy) Boston, MA 02118 12/20/2022 11:14 AM
AddressesShipping AddressDeleteChange RequestBoston Medical Center 625 Albany Street Newton Pavilion Loading Dock Boston, MA 02118 12/20/2022 11:14 AM
AddressesShipping AddressInsertChange Request Boston Medical Center Outpatient Pharmacy - Preston Building 732 Harrison Ave. Boston, MA 02118-230912/20/2022 11:14 AM
DetailsLast Recertification DateUpdateRecertification8/25/2021 11:22:13 AM8/29/2022 10:17:40 AM8/29/2022 10:17 AM
AddressesShipping AddressInsertChange Request Boston Medical Center Pharmacy at Manet 110 W. Squantum St. Pharmacy Quincy, MA 02171-212211/9/2021 9:58 AM
DetailsLast Recertification DateUpdateRecertification8/25/2020 9:10:39 AM8/25/2021 11:22:13 AM8/25/2021 11:22 AM
Medicaid BillingNPI: NumberInsertChange Request 19428191641/14/2021 9:19 AM
Medicaid BillingNPI: StateInsertChange Request MA1/14/2021 9:19 AM
Medicaid BillingNPI: NumberInsertChange Request 17408992441/14/2021 9:19 AM
Medicaid BillingNPI: StateInsertChange Request MA1/14/2021 9:19 AM
Medicaid BillingMedicaid: NumberDeleteRecertification110022129J (MA) 8/25/2020 9:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/25/2020 9:10 AM
Medicaid BillingMedicaid: NumberInsertRecertification 110092155F8/25/2020 9:10 AM
Medicaid BillingMedicaid: StateInsertRecertification MA8/25/2020 9:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/25/2020 9:10 AM
Medicaid BillingMedicaid: NumberInsertRecertification 110092155K8/25/2020 9:10 AM
Medicaid BillingMedicaid: StateInsertRecertification MA8/25/2020 9:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/25/2020 9:10 AM
Medicaid BillingMedicaid: NumberInsertRecertification 110092155N8/25/2020 9:10 AM
Medicaid BillingMedicaid: StateInsertRecertification MA8/25/2020 9:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/25/2020 9:10 AM
Medicaid BillingMedicaid: NumberInsertRecertification 110092155O8/25/2020 9:10 AM
Medicaid BillingMedicaid: StateInsertRecertification MA8/25/2020 9:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/25/2020 9:10 AM
Medicaid BillingMedicaid: NumberInsertRecertification 110092155N8/25/2020 9:10 AM
Medicaid BillingMedicaid: StateInsertRecertification NH8/25/2020 9:10 AM
Medicaid BillingNPI: StateUpdateRecertification MA8/25/2020 9:10 AM
Medicaid BillingNPI: StateUpdateRecertification MA8/25/2020 9:10 AM
Medicaid BillingNPI: NumberInsertRecertification 10831416598/25/2020 9:10 AM
Medicaid BillingNPI: StateInsertRecertification NH8/25/2020 9:10 AM
Medicaid BillingNPI: StateUpdateRecertification MA8/25/2020 9:10 AM
Medicaid BillingNPI: StateUpdateRecertification MA8/25/2020 9:10 AM
Medicaid BillingNPI: StateUpdateRecertification MA8/25/2020 9:10 AM
Medicaid BillingNPI: StateUpdateRecertification MA8/25/2020 9:10 AM
DetailsLast Recertification DateUpdateRecertification8/28/2019 10:11:32 AM8/25/2020 9:10:39 AM8/25/2020 9:10 AM
AddressesShipping AddressInsertChange Request BMC Pharmacy at Codman Square 637 Washington St. Pharmacy Dorchester, MA 021243/13/2020 1:04 PM
Medicaid BillingNPI: NumberInsertChange Request 12054731623/13/2020 1:04 PM
AddressesShipping AddressDeleteRecertificationBoston Medical Center 88 East Newton Street H2606 (Inpatient Pharmacy) Boston, MA 02118 8/28/2019 10:11 AM
DetailsLast Recertification DateUpdateRecertification8/20/2018 1:04:03 PM8/28/2019 10:11:32 AM8/28/2019 10:11 AM
DetailsLast Recertification DateUpdateRecertification11/15/2017 9:42:00 PM8/20/2018 1:04:03 PM8/20/2018 1:04 PM
DetailsLast Recertification DateUpdateRecertification8/15/2016 12:00:00 AM11/15/2017 9:42:00 PM11/15/2017 9:42 PM
ContactsPrimary ContactUpdateProfile Change RequestPalinkas, Noreen A. 340B Compliance Manager Boston Medical Center 6176385843Palinkas, Noreen A. Director Pharmacy Compliance Boston Medical Center 617638584311/6/2017 11:16 AM
AddressesShipping AddressInsertChange Request Boston Medical Center Menino Pavilion 840 Harrison Ave., Basement Boston, MA 0211810/4/2017 10:17 AM
Medicaid BillingNPI: NumberInsertChange Request 108314165910/4/2017 10:17 AM
ContactsAuthorizing OfficialUpdate Walsh, Kathleen E. Chief Executive Officer 6176386911Walsh, Kathleen E. Chief Executive Officer Boston Medical Center 61763869119/19/2017 1:13 PM
ContactsPrimary ContactUpdate Palinkas, Noreen A. 340B Compliance Manager 6176385843Palinkas, Noreen A. 340B Compliance Manager Boston Medical Center 61763858439/19/2017 1:03 PM
AddressesShipping AddressDelete Boston Medical Center Menino Pavilion Inpatient Pharmacy 840 Harrison Ave., Basement Boston, MA 02118 8/7/2017 3:02 PM
AddressesMain AddressInsert   1 Boston Medical Center Place BOSTON, MA 021188/7/2017 3:02 PM
AddressesBilling AddressInsert  Boston Medical Center 850 Harrison Avenue YACC Basement (Outpatient Pharmacy Offices) BOSTON, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 818 Harrison Ave Yawkey Ambulatory Care Center Level 1 (OP Pharmacy) Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 750 Albany St Menino Pavilion Loading Dock Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 818 Harrison Ave Menino Pavilion 5 (Inpatient Pharmacy) Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 88 East Newton Street Doctor's Office Building 1 (DOB Pharmacy) Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 88 East Newton Street H2606 (Inpatient Pharmacy) Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 625 Albany Street Newton Pavilion Loading Dock Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 725 Albany St Shapiro Pharmacy Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 720 Harrison Ave Pharmacy Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 850 Harrison Ave Pharmacy Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center Menino Pavilion Inpatient Pharmacy 840 Harrison Ave., Basement Boston, MA 021188/7/2017 3:02 PM
AddressesShipping AddressInsert  Safecor Health, LLC 317 New Boston Street Suite 100 Woburn, MA 018018/7/2017 3:02 PM
AddressesShipping AddressInsert  Boston Medical Center 41 Teed Dr. Cornerstone Health Solutions Randolph, MA 023688/7/2017 3:02 PM
ContactsAuthorizing OfficialInsert  Walsh, Kathleen E. Chief Executive Officer 61763869118/7/2017 3:02 PM
ContactsPrimary ContactUpdate Twitchell, David Director of Pharmacy 6176386799Palinkas, Noreen A. 340B Compliance Manager 61763858438/7/2017 3:02 PM
ContactsPrimary ContactInsert  Twitchell, David Director of Pharmacy 617638679912/7/2016 7:42 AM
DetailsLast Recertification DateUpdate 8/10/2015 12:00:00 AM8/15/2016 12:00:00 AM8/15/2016 1:31 PM
DetailsLast Recertification DateUpdate 8/14/2014 12:00:00 AM8/10/2015 12:00:00 AM8/10/2015 9:38 AM
DetailsLast Recertification DateUpdate 9/10/2013 12:00:00 AM8/14/2014 12:00:00 AM8/14/2014 2:45 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM9/10/2013 12:00:00 AM9/10/2013 2:01 PM
Medicaid BillingNPI: NumberInsert  10839523293/29/2013 8:48 AM
Medicaid BillingNPI: NumberInsert  13664331045/29/2012 12:22 PM
Medicaid BillingNPI: NumberInsert  11149189505/29/2012 12:22 PM
Medicaid BillingNPI: NumberInsert  13462182945/29/2012 12:22 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/29/2012 12:22 PM
DetailsEntity SubnameUpdate HARRISON PAVILLION 5/29/2012 12:22 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False5/29/2012 12:22 PM
Medicaid BillingMedicaid: NumberInsert  110022129J5/29/2012 12:22 PM
Medicaid BillingMedicaid: StateInsert  MA5/29/2012 12:22 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False5/29/2012 12:22 PM
Medicaid BillingMedicaid: NumberInsert  110022129A5/29/2012 12:22 PM
Medicaid BillingMedicaid: StateInsert  MA5/29/2012 12:22 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse5/29/2012 12:22 PM
Medicaid BillingMedicaid: NumberUpdate 0447137110022129B5/29/2012 12:22 PM
DetailsLast Recertification DateInsert   2/24/2010 1:55 PM
DetailsGrant NumberInsert   2/24/2010 1:55 PM
Details340B IDInsert  DSH2200312/24/2010 1:55 PM
DetailsIs Authorizing Official EHB DataInsert   2/24/2010 1:55 PM
DatesLast Date That 340B Drugs PurchasedInsert   2/24/2010 1:55 PM
DetailsMedicare Provider NumberInsert  2200312/24/2010 1:55 PM
DetailsEntity NameInsert  BOSTON MEDICAL CENTER2/24/2010 1:55 PM
DetailsProgram CodeInsert  DSH2/24/2010 1:55 PM
DetailsEntity SubnameInsert  HARRISON PAVILLION2/24/2010 1:55 PM
DatesParticipating Approval DateInsert  9/10/2007 12:00:00 AM2/24/2010 1:55 PM
DetailsStateInsert  Active2/24/2010 1:55 PM
DatesRegistration DateInsert  9/10/2007 12:00:00 AM2/24/2010 1:55 PM
DatesSigned By DateInsert   2/24/2010 1:55 PM
DatesStart DateInsert  12/1/1992 12:00:00 AM2/24/2010 1:55 PM
TerminationsTermination CommentsInsert   2/24/2010 1:55 PM
TerminationsTermination DateInsert   2/24/2010 1:55 PM
TerminationsTermination Effective DateInsert   2/24/2010 1:55 PM
TerminationsTermination ReasonInsert   2/24/2010 1:55 PM
DetailsComments PublicInsert  2/24/10 UPDATED ADDR (WAS 850 HARRISON AVE) AND ADDED BILL TO; 1/19/10 UPDATED ADDR (WAS 818 HARRISON AVE AMBULATORY CARE CTR); 1/14/10 ADDED SHIP TO ADDR2/24/2010 1:55 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True9/10/2007 9:49 AM
Medicaid BillingMedicaid: NumberInsert  04471379/10/2007 9:49 AM
Medicaid BillingMedicaid: StateInsert  MA9/10/2007 9:49 AM