Contract Pharmacy Details

CVS MANCHESTER NH, L.L.C.
DSH220033 BEVERLY HOSPITAL

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 MANCHESTER NH, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 00503
628 LAFAYETTE RD.
SEABROOK, NH 03874

Pharmacy Comments

Contract Details

Approval Date

7/5/2020

Contract Begin Date

10/1/2020

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

7/5/2020

340B Drug Pricing Program Database