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LAHEY CLINIC HOSPITAL INC
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
NU52PS910302
Participating Start Date
1/1/1999
Last Recertification Date
5/28/2025
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
1/13/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennifer Cochran, Director, Tuberculosis Program
(617) 983-6596
Contract Pharmacy Representative
Keith Thomasset, Pharmacy Director
(781) 744-5077
Signed By Date
1/13/2015
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