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CVS PHARMACY, INC.
DSH220035 NORTH SHORE MEDICAL CENTER
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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 # 04073
174 MAIN ST.
PEABODY, MA 01960
Pharmacy Comments
Contract Details
Approval Date
3/31/2013
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, Senior Vice President of Finance
(617) 724-4537
Contract Pharmacy Representative
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
1/15/2013
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