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FITCHBURG FAMILY 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
FITCHBURG FAMILY PHARMACY, INC.
Pharmacy Address
326 NICHOLS RD
FITCHBURG, MA 01420
Pharmacy Comments
Contract Details
Approval Date
7/8/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/6/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Deborah Weymouth, President, CEO
(978) 466-2190
Contract Pharmacy Representative
Matt Moen, VP Clinical Services
(508) 755-4173
Signed By Date
7/8/2015
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