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MAXI DRUG, INC.
DSH220046 BERKSHIRE MEDICAL CENTER
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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 #10067
180 ELM STREET SUITE J
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
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