Contract Pharmacy Details

CVS PHARMACY, INC.
DSH220177 NANTUCKET COTTAGE HOSPITAL

Covered Entity Details

Entity Name

NANTUCKET COTTAGE HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220177

Entity Address

57 PROSPECT STREET
NANTUCKET, MA 02554-2799

Medicare Provider Number

220177

Participating Start Date

3/15/2022

Last Recertification Date

9/8/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 01869
1080 FALMOUTH RD.
HYANNIS, MA 02601

Pharmacy Comments

Contract Details

Approval Date

10/13/2022

Contract Begin Date

1/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Aaron S Fishman, VP, Finance
(508) 825-8205

Contract Pharmacy Representative

WELLPARTNER, A CVS HEALTH COMPANY
TOM ALBERTSON, NATIONAL SALES EXECUTIVE
(203) 343-3285

Signed By Date

10/13/2022

340B Drug Pricing Program Database