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CVS PHARMACY, INC.
CH012010 MATTAPAN COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MATTAPAN COMMUNITY HEALTH CENTER, INC.
Subdivision Name
Mattapan Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH012010
Entity Address
1575 Blue Hill Ave
Mattapan, MA 02126-2122
Grant Number
H80CS00395
Participating Start Date
7/1/2002
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA CVS/PHARMACY # 5464
1575 BLUE HILL AVE
MATTAPAN, MA 02126
Pharmacy Comments
Contract Details
Approval Date
10/15/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/23/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
AZZIE YOUNG, CEO
(617) 898-9020
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
10/15/2013
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