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GENERAL HOSPITAL CORPORATION
RWI02114 Massachusetts General Hospital
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Covered Entity Details
Entity Name
Massachusetts General Hospital
Subdivision Name
Infectious Disease Associates, Cox 5
Type
Ryan White Part A
340B ID
RWI02114
Entity Address
55 Fruit Street
Cox 5
Boston, MA 02114
Grant Number
H89HA00011
Participating Start Date
7/1/2018
Last Recertification Date
Entity Termination Date
1/1/2019
Pharmacy Details
Pharmacy Name
GENERAL HOSPITAL CORPORATION
Pharmacy Address
OUTPATIENT PHARMACY ATTN: ERIN STACK
55 FRUIT STREET
BOSTON, MA 02114
Pharmacy Comments
Contract Details
Approval Date
7/16/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JAMES HEFFERNAN, SR. VP OF FINANCE AND TREASURER
(617) 726-2684
Contract Pharmacy Representative
Massachusetts General Hospital
Rafic Nehme, Director, Pharmacy Business & Finance
(617) 726-5125
Signed By Date
7/16/2018
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