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UMASS MEMORIAL MEDICAL CENTER, INC.
DSH220095 HENRY HEYWOOD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HENRY HEYWOOD MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220095
Entity Address
242 GREEN STREET
GARDNER, MA 01440
Medicare Provider Number
220095
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
UMASS MEMORIAL MEDICAL CENTER, INC.
Pharmacy Address
UMASS MEMORIAL MEDICAL CENTER SPECIALTY
55 LAKE AVE N
ACC BUILDING - 1ST FLOOR - SUITE AC1.033
WORCESTER, MA 01655-0002
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/13/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
ROBERT CROSBY, SR.VP FINANCE & CFO
(978) 630-6157
Contract Pharmacy Representative
UMass Memorial Medical Center
Alice Shakman, Vice President Operations
(774) 443-0540
Signed By Date
7/12/2018
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