Contract Pharmacy Details

MAXI DRUG, INC.
DSH220019 UMass Memorial Health - Harrington Hospital, Inc.

Covered Entity Details

Entity Name

UMass Memorial Health - Harrington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220019

Entity Address

100 SOUTH STREET
SOUTHBRIDGE, MA 01550

Medicare Provider Number

220019

Participating Start Date

7/1/2009

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

MAXI DRUG, INC.

Pharmacy Address

RITE AID #10091
182 MAIN ST.
STURBRIDGE, MA 01566

Pharmacy Comments

Contract Details

Approval Date

7/11/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/15/2018
Ownership change

Contacts

Covered Entity Signing Official

THOMAS J. SULLIVAN, Vice President & CFO
(508) 765-8130

Contract Pharmacy Representative

Rite Aid
Linda VonMinden, Director Managed Care
(951) 695-0621

Signed By Date

7/11/2016

340B Drug Pricing Program Database