Contract Pharmacy Details

CVS PHARMACY, INC.
DSH220035 NORTH SHORE MEDICAL CENTER

Covered Entity Details

Entity Name

NORTH SHORE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220035

Entity Address

81 HIGHLAND AVENUE
SALEM, MA 01970

Medicare Provider Number

220035

Participating Start Date

9/5/2008

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 00669
413 PARADISE RD STE A
SWAMPSCOTT, MA 01907

Pharmacy Comments

Contract Details

Approval Date

3/8/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/4/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Sally Mason Boemer, SVP Finance
(978) 741-1200

Contract Pharmacy Representative

Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

1/15/2013

340B Drug Pricing Program Database