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CAPE COD HEALTHCARE PHARMACY AT FALMOUTH
TB02540 CAPE COD HOSPITAL
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Covered Entity Details
Entity Name
CAPE COD HOSPITAL
Subdivision Name
TB Clinic at Infectious Disease Clinical Services (IDCS) of Falmouth Hospital
Type
Tuberculosis
340B ID
TB02540
Entity Address
100 Ter Heun Drive
Falmouth, MA 02540
Grant Number
6NU52PS910185
Participating Start Date
4/1/2020
Last Recertification Date
5/14/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
CAPE COD HEALTHCARE PHARMACY AT FALMOUTH
Pharmacy Address
100 TER HEUN DR
FALMOUTH, MA 02540-2503
Pharmacy Comments
Contract Details
Approval Date
3/5/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Valerie Nicole Al-Hachem, Infectious Disease Director & Grants Administrator
(508) 862-5639
Contract Pharmacy Representative
Cape Cod Healthcare
Angela M Medeiros, Pharmacy Director
(508) 862-5903
Signed By Date
1/15/2020
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