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CONNECTICUT CVS PHARMACY, L.L.C.
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
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 00459
2639 MAIN STREET
GLASTONBURY, CT 06033
Pharmacy Comments
Contract Details
Approval Date
4/22/2021
Contract Begin Date
4/23/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Cullen, CFO
(617) 667-7146
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/22/2021
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