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BILH PHARMACY, 364 BROOKLINE AVE, BOSTON
DSH220033BK BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
LAHEY OUTPATIENT CENTER DANVERS - DAN DIABETES CARE CENTER - ENDOCRINOLOGY
Type
Disproportionate Share Hospital
340B ID
DSH220033BK
Entity Address
480 Maple Street
Suite 103
Danvers, MA 01923
Medicare Provider Number
220033
Outpatient Facility Provider Number
Participating Start Date
7/1/2018
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
BILH PHARMACY, 364 BROOKLINE AVE, BOSTON
Pharmacy Address
364 BROOKLINE AVE
SHAPIRO LOBBY PHARMACY
BOSTON, MA 02215
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tom Sands, President
(978) 816-2580
Contract Pharmacy Representative
BILH Pharmacy
Michael Nguyen, Pharmacy Manager
(617) 667-6199
Signed By Date
4/18/2023
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