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BILH PHARMACY, 364 BROOKLINE AVE, BOSTON
DSH220086 BETH ISRAEL DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220086
Entity Address
330 Brookline Ave
BOSTON, MA 02215
Medicare Provider Number
220086
Participating Start Date
10/1/2009
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
BILH PHARMACY, 364 BROOKLINE AVE, BOSTON
Pharmacy Address
364 BROOKLINE AVE
SHAPIRO LOBBY PHARMACY
BOSTON, MA 02215
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
10/15/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Cullen, CFO
(617) 667-7146
Contract Pharmacy Representative
BILH Pharmacy
Michael Nguyen, Pharmacy Manager
(617) 667-6199
Signed By Date
10/15/2018
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