Contract Pharmacy Details

CVS PHARMACY, INC.
CHC29010-00 UPHAMS CORNER HEALTH COMMITTEE, INC.

Covered Entity Details

Entity Name

UPHAMS CORNER HEALTH COMMITTEE, INC.

Subdivision Name

Upham's Corner Health Center

Type

HRSA-Funded Health Center

340B ID

CHC29010-00

Entity Address

415 Columbia Rd
Dorchester, MA 02125-2424

Grant Number

H80CS29010

Participating Start Date

1/1/2016

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 01264
704 CENTRE STREET
JAMAICA PLAIN, MA 02130

Pharmacy Comments

Contract Details

Approval Date

1/15/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/20/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jagdeep Trivedi, CEO
(617) 287-8000 Ext: 8131

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/15/2020

340B Drug Pricing Program Database