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ACARIAHEALTH PHARMACY, INC.
RRC220110-00 BRIGHAM AND WOMENS HOSPITAL
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Covered Entity Details
Entity Name
BRIGHAM AND WOMENS HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC220110-00
Entity Address
75 FRANCIS STREET
BOSTON, MA 02115
Medicare Provider Number
220110
Participating Start Date
1/1/2019
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
ACARIAHEALTH PHARMACY, INC.
Pharmacy Address
260 FORDHAM RD STE E
WILMINGTON, MA 01887-2170
Pharmacy Comments
Contract Details
Approval Date
1/7/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christopher Dunleavy, Chief Financial Officer
(617) 732-7899
Contract Pharmacy Representative
Acaria Health
Philip Gofman, Regional VP
(917) 312-5263
Signed By Date
1/7/2020
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