Contract Pharmacy Details

LEMUEL SHATTUCK HOSPITAL
TB021309 THE COMMONWEALTH OF MASSACHUSETTS DEPT OF PUBLIC HEALTH

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

LEMUEL SHATTUCK HOSPITAL

Pharmacy Address

DBA OFFICE FOR PHARMACY SERVICES
170 MORTON ST
JAMAICA PLAIN, MA 02130-3735

Pharmacy Comments

Contract Details

Approval Date

1/13/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jennifer Cochran, Director, Tuberculosis Program
(617) 983-6596

Contract Pharmacy Representative

Mathew Ambury, Pharmacy Director
(617) 971-3122

Signed By Date

1/13/2015

340B Drug Pricing Program Database