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CORAM HEALTHCARE CORPORATION OF MASSACHU
DSH220071 MASSACHUSETTS GENERAL HOSPITAL
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Covered Entity Details
Entity Name
MASSACHUSETTS GENERAL HOSPITAL
Subdivision Name
The General Hospital Corporation
Type
Disproportionate Share Hospital
340B ID
DSH220071
Entity Address
55 FRUIT STREET
BOSTON, MA 02114
Medicare Provider Number
220071
Participating Start Date
3/24/2021
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CORAM HEALTHCARE CORPORATION OF MASSACHU
Pharmacy Address
CORAM CVS/SPECIALTY INFUSION SERVICES
575 UNIVERSITY AVENUE
SUITE 2
NORWOOD, MA 02062
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Pharmacy closed
Contacts
Covered Entity Signing Official
Sally Mason Boemer, Senior Vice President of Finance
(617) 724-4537
Contract Pharmacy Representative
Massachusetts General Hospital
Rafic Nehme, Director, Pharmacy Business & Finance
(617) 726-5125
Signed By Date
7/17/2023
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