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CVS PHARMACY, INC.
DSH220033 BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220033
Entity Address
85 HERRICK STREET
BEVERLY, MA 01915
Medicare Provider Number
220033
Participating Start Date
4/1/2013
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 00672
32 FERRY STREET
MALDEN, MA 02148
Pharmacy Comments
Contract Details
Approval Date
4/8/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Connie Woodworth, Vice President Finance
(978) 922-3000 Ext: 2587
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2020
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