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MAXIM PHARMACY
CH010170 Harbor Health Services, Inc.
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Covered Entity Details
Entity Name
Harbor Health Services, Inc.
Subdivision Name
DANIEL DRISCOLL - NEPONSET HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH010170
Entity Address
398 NEPONSET AVE
DORCHESTER, MA 02122
Grant Number
H80CS00743
Participating Start Date
4/1/2002
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
MAXIM PHARMACY
Pharmacy Address
1365 DORCHESTER AVE
(1365-1377 DORCHESTER AVE)
DORCHESTER, MA 02122
Pharmacy Comments
Contract Details
Approval Date
10/15/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charles T. Jones, CEO
(617) 533-2350
Contract Pharmacy Representative
Maxim Pharmacy
Hieu Vinh, Manager
(617) 282-9800
Signed By Date
10/15/2022
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