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CVS PHARMACY, INC.
DSH220001 HealthAlliance-Clinton Hospital
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Covered Entity Details
Entity Name
HealthAlliance-Clinton Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220001
Entity Address
60 HOSPITAL ROAD
LEOMINSTER, MA 01453
Medicare Provider Number
220001
Participating Start Date
10/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 00505
161 MAIN STREET
FITCHBURG, MA 01420
Pharmacy Comments
Contract Details
Approval Date
4/25/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/3/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mike Cofone, CFO
(978) 466-2185
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/25/2014
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