Contract Pharmacy Details

CVS PHARMACY, INC.
DSH220031 BOSTON MEDICAL CENTER

Covered Entity Details

Entity Name

BOSTON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220031

Entity Address

1 Boston Medical Center Place
BOSTON, MA 02118

Medicare Provider Number

220031

Participating Start Date

12/1/1992

Last Recertification Date

8/21/2024

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 01049
942A HYDE PARK AVENUE
HYDE PARK, MA 02136

Pharmacy Comments

Contract Details

Approval Date

7/24/2013

Contract Begin Date

10/1/2013

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kathleen E. Walsh, Chief Executive Officer
(617) 638-6911

Contract Pharmacy Representative

CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298

Signed By Date

7/24/2013

340B Drug Pricing Program Database