Contract Pharmacy Details

MAXI DRUG, INC.
DSH220046 BERKSHIRE MEDICAL CENTER

Covered Entity Details

Entity Name

BERKSHIRE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220046

Entity Address

725 NORTH STREET
PITTSFIELD, MA 01201

Medicare Provider Number

220046

Participating Start Date

1/1/2010

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

MAXI DRUG, INC.

Pharmacy Address

RITE AID #10066
163 SOUTH ST.
PITTSFIELD, MA 01201

Pharmacy Comments

Contract Details

Approval Date

1/7/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2018
Ownership change

Contacts

Covered Entity Signing Official

DARLENE RODOWICZ, Executive Vice President & Treasurer
(413) 447-2809

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

1/7/2014

340B Drug Pricing Program Database