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CVS PHARMACY, INC.
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
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 01852
67D MAIN ST.
MEDWAY, MA 02053
Pharmacy Comments
Contract Details
Approval Date
10/18/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Marsha Lynn Maurer, Senior Vice President, Chief Nursing Officer
(617) 667-1747
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/18/2022
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