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CVS PHARMACY, INC.
DSH220116 TUFTS MEDICAL CENTER
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Covered Entity Details
Entity Name
TUFTS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220116
Entity Address
800 WASHINGTON STREET
BOSTON, MA 02111
Medicare Provider Number
220116
Participating Start Date
10/1/2003
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 01217
587 BOYLSTON STREET
BOSTON, MA 02116
Pharmacy Comments
Contract Details
Approval Date
10/4/2012
Contract Begin Date
10/4/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chibueze Agba, CFO
(617) 636-4242
Contract Pharmacy Representative
John R. Zevzavadjian, Vice President, Managed Care
(401) 770-5503
Signed By Date
9/29/2012
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