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LAHEY CLINIC HOSPITAL INC
DSH220033 BEVERLY HOSPITAL
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Covered Entity Details
Entity Name
BEVERLY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220033
Entity Address
85 HERRICK STREET
BEVERLY, MA 01915
Medicare Provider Number
220033
Participating Start Date
4/1/2013
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
LAHEY CLINIC HOSPITAL INC
Pharmacy Address
C/O PHARMACY DEPT
41 MALL RD
BURLINGTON, MA 01805
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Connie Woodworth, Vice President Finance
(978) 922-3000 Ext: 2587
Contract Pharmacy Representative
Nancy Huff, Director of Pharmacy
(781) 744-5077
Signed By Date
7/17/2017
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