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TUFTS MEDICINE HOME INFUSION SERVICES
DSH220116 TUFTS MEDICAL CENTER
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Covered Entity Details
Entity Name
TUFTS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220116
Entity Address
800 WASHINGTON STREET
BOSTON, MA 02111
Medicare Provider Number
220116
Participating Start Date
10/1/2003
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
TUFTS MEDICINE HOME INFUSION SERVICES
Pharmacy Address
170 GOVERNORS AVE
MEDFORD, MA 02155
Pharmacy Comments
Contract Details
Approval Date
7/18/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Assad Siddiqi, Senior Vice President of Finance
(617) 636-7767
Contract Pharmacy Representative
Tufts Medicine
Keith Thomasset, SVP Pharmacy
(978) 942-2160
Signed By Date
7/18/2022
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