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CVS PHARMACY, INC.
DSH220095 HENRY HEYWOOD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
HENRY HEYWOOD MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220095
Entity Address
242 GREEN STREET
GARDNER, MA 01440
Medicare Provider Number
220095
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 01050
160 RESERVOIR ROAD
HOLDEN, MA 01520
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Bujak, Chief Financial Officer
(978) 630-6202
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/14/2025
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