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MELROSEWAKEFIELD HEALTHCARE
TB021309 THE COMMONWEALTH OF MASSACHUSETTS DEPT OF PUBLIC HEALTH
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Covered Entity Details
Entity Name
THE COMMONWEALTH OF MASSACHUSETTS DEPT OF PUBLIC HEALTH
Subdivision Name
DIV OF TB PREVENTION & CONTROL (STATE LAB)
Type
Tuberculosis
340B ID
TB021309
Entity Address
305 SOUTH STREET
JAMAICA PLAIN, MA 02130
Grant Number
6NU52PS910185
Participating Start Date
1/1/1999
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
MELROSEWAKEFIELD HEALTHCARE
Pharmacy Address
MELROSE-WAKEFIELD HOSPITAL CAMPUS
585 LEBANON ST
MELROSE, MA 02176-3225
Pharmacy Comments
Contract Details
Approval Date
1/13/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Cochran, Director, Tuberculosis Program
(617) 983-6596
Contract Pharmacy Representative
Michelle Corrado, Pharmacy Director
(781) 979-3190
Signed By Date
1/13/2015
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