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CVS PHARMACY, INC.
DSH220074 SOUTHCOAST HOSPITALS GROUP, INC
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Covered Entity Details
Entity Name
SOUTHCOAST HOSPITALS GROUP, INC
Subdivision Name
DBA CHARLTON MEMORIAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH220074
Entity Address
363 HIGHLAND AVENUE
FALL RIVER, MA 02720
Medicare Provider Number
220074
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 00685
1145 KEMPTON STREET
NEW BEDFORD, MA 02740
Pharmacy Comments
Contract Details
Approval Date
10/9/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Renee Clark, Exec. Vice President & Chief Operating Officer
(508) 973-5872
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/9/2023
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