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MAXI DRUG, 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
MAXI DRUG, INC.
Pharmacy Address
RITE AID #10150
1100 DORCHESTER AVENUE
DORCHESTER, MA 02125
Pharmacy Comments
Contract Details
Approval Date
12/3/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/21/2018
Ownership change
Contacts
Covered Entity Signing Official
Chibueze Agba, CFO
(617) 636-4242
Contract Pharmacy Representative
Rite Aid
Ruth Lightner, Director
(717) 731-6524
Signed By Date
10/12/2012
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