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BILH PHARMACY 41 MALL RD, BURLINGTON
DSH220086 BETH ISRAEL DEACONESS MEDICAL CENTER
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Covered Entity Details
Entity Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220086
Entity Address
330 Brookline Ave
BOSTON, MA 02215
Medicare Provider Number
220086
Participating Start Date
10/1/2009
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
BILH PHARMACY 41 MALL RD, BURLINGTON
Pharmacy Address
41 MALL RD
BURLINGTON, MA 01805
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Larkin, Chief Operating Officer
(617) 677-7144
Contract Pharmacy Representative
Lahey
Mary A Caban, Pharmacy Manager
(781) 744-8658
Signed By Date
4/10/2024
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