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BILH PHARMACY DIRECT
DSH220086 BETH ISRAEL DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220086
Entity Address
330 Brookline Ave
BOSTON, MA 02215
Medicare Provider Number
220086
Participating Start Date
10/1/2009
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
BILH PHARMACY DIRECT
Pharmacy Address
80 WILSON WAY
SUITE A
WESTWOOD, MA 02090
Pharmacy Comments
Contract Details
Approval Date
10/20/2020
Contract Begin Date
10/20/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Cullen, CFO
(617) 667-7146
Contract Pharmacy Representative
BILH Pharmacy
Matt Pungitore, Pharmacy Direct Manager
(781) 352-6533
Signed By Date
10/20/2020
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