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CONNECTICUT CVS PHARMACY, L.L.C.
DSH220163 UMASS MEMORIAL MEDICAL CENTER
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Covered Entity Details
Entity Name
UMASS MEMORIAL MEDICAL CENTER
Subdivision Name
UNIVERSITY CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH220163
Entity Address
55 LAKE AVENUE NORTH
WORCESTER, MA 01655
Medicare Provider Number
220163
Participating Start Date
10/1/2003
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY # 17489
2177 KILLINGLY CMNS
DAYVILLE, CT 06241
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alice Shakman, Vice President Operations
(774) 443-0540
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2022
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