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WESTERN PHARMACY GROUP LLC
DSH220095 HENRY HEYWOOD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HENRY HEYWOOD MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220095
Entity Address
242 GREEN STREET
GARDNER, MA 01440
Medicare Provider Number
220095
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
WESTERN PHARMACY GROUP LLC
Pharmacy Address
DBA GALLOWAY'S MEDICAL CENTER PHARMACY
2995 NATIONAL AVE
SAN DIEGO, CA 92113-2419
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Michael Abbatiello, CFO
(978) 630-6157
Contract Pharmacy Representative
Western Pharmacy Group LLC
KEVIN FARIS, CEO
(360) 685-4263
Signed By Date
10/14/2020
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