Contract Pharmacy Details

MAXI DRUG, INC.
DSH220116 TUFTS MEDICAL CENTER

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 #10170
132 GRANITE STREET
QUINCY, MA 02169

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