Contract Pharmacy Details

MAXI DRUG, INC.
DSH220116 TUFTS MEDICAL CENTER

Covered Entity Details

Entity Name

TUFTS MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220116

Entity Address

800 WASHINGTON STREET
BOSTON, MA 02111

Medicare Provider Number

220116

Participating Start Date

10/1/2003

Last Recertification Date

8/13/2024

Pharmacy Details

Pharmacy Name

MAXI DRUG, INC.

Pharmacy Address

RITE AID #10150
1100 DORCHESTER AVENUE
DORCHESTER, MA 02125

Pharmacy Comments

Contract Details

Approval Date

7/17/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2018
Ownership change

Contacts

Covered Entity Signing Official

Kristine Hanscom, CFO
(617) 636-7767

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

7/17/2018

340B Drug Pricing Program Database