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CVS PHARMACY, INC.
DSH220116 TUFTS MEDICAL CENTER
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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
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 01252
874 HARRISON AVE
BOSTON, MA 02118
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
4/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Kristine Hanscom, CFO
(617) 636-7767
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/17/2018
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