Contract Pharmacy Details

MAXI DRUG, INC.
DSH220019 UMass Memorial Health - Harrington Hospital, Inc.

Covered Entity Details

Entity Name

UMass Memorial Health - Harrington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220019

Entity Address

100 SOUTH STREET
SOUTHBRIDGE, MA 01550

Medicare Provider Number

220019

Participating Start Date

7/1/2009

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

MAXI DRUG, INC.

Pharmacy Address

RITE AID #10092
80 EAST MAIN STREET
WEBSTER, MA 01570

Pharmacy Comments

Contract Details

Approval Date

7/20/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2023
Pharmacy closed

Contacts

Covered Entity Signing Official

Edward Moore, President
(508) 765-3002

Contract Pharmacy Representative

RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086

Signed By Date

7/20/2023

340B Drug Pricing Program Database