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CVS MANCHESTER NH, L.L.C.
DSH220063 THE LOWELL GENERAL HOSPITAL
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Covered Entity Details
Entity Name
THE LOWELL GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220063
Entity Address
295 VARNUM AVENUE
LOWELL, MA 01854
Medicare Provider Number
220063
Participating Start Date
4/1/2004
Last Recertification Date
9/12/2024
Pharmacy Details
Pharmacy Name
CVS MANCHESTER NH, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00639
242 MAIN STREET
NASHUA, NH 03060
Pharmacy Comments
Contract Details
Approval Date
4/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William F Wyman, SVP of Operations & Treasurer
(978) 937-6034
Contract Pharmacy Representative
Caremark L.L.C.
Christian reid, 340b Program Director
(401) 770-2118
Signed By Date
4/2/2019
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