Contract Pharmacy Details

ATHOL PHARMACY INC.
CAH221303-00 Athol Memorial Hospital

Covered Entity Details

Entity Name

Athol Memorial Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH221303-00

Entity Address

2033 Main St.
Athol, MA 01331

Medicare Provider Number

221303

Participating Start Date

4/1/2013

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

ATHOL PHARMACY INC.

Pharmacy Address

ATHOL PHARMACY
290 MAIN ST
ATHOL, MA 01331

Pharmacy Comments

Contract Details

Approval Date

4/17/2023

Contract Begin Date

4/24/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/15/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Tom Sullivan, CFO
(978) 630-6157

Contract Pharmacy Representative

Chair City Pharmacy
Steven MacNeill, President
(978) 201-5247

Signed By Date

4/17/2023

340B Drug Pricing Program Database