Covered Entity Details

DSH220077AX BAYSTATE MEDICAL CENTER (Approved) - information as of 4/25/2025 6:36:09 PM

Main Details

Name

BAYSTATE MEDICAL CENTER

Subdivision Name

BAYSTATE INFUSION CENTER NOBLE HOSP - Baystate Infusion - Noble Sat

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH220077AX

Medicare Provider Number

220077

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/7/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/8/2025

Last Recertification Date

Contacts

Authorizing Official

Baystate Health
Raymond P McCarthy, SVP, Chief Financial Officer & Treasurer
(413) 794-3290

Primary Contact

Baystate Health
Nancy Cruz, Pharmacy Compliance Manager
(413) 794-8282

Addresses

Street Address

115 W SILVER ST
3RD FLOOR
WESTFIELD, MA 01085-3678

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
MA	110020829H	1487655064

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH220077A	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE HIGH STREET HEALTH CENTER	140 HIGH STREET	SPRINGFIELD	MA	Active
DSH220077AA	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Gynecology Oncology	3300 Main Street	Springfield	MA	Active
DSH220077AB	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Behavioral Health and Child Psychiatry	3300 Main Street	Springfield	MA	Active
DSH220077AC	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Child Partial Hospitalization Program	150 Lower Westfield Road	Holyoke	MA	Active
DSH220077AD	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Breast and Wellness Center	100 Wason Avenue	Springfield	MA	Active
DSH220077AE	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Endocrinology	3300 Main Street	Springfield	MA	Active
DSH220077AF	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Gastroenterology	3300 Main Street	Springfield	MA	Active
DSH220077AG	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Neurology	3300 Main street	Springfield	MA	Active
DSH220077AH	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Infectious Disease	3300 Main Street	springfield	MA	Active
DSH220077AJ	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Neuropsychology Services	3300 Main St	Springfield	MA	Active
DSH220077AK	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Pulmonary & Critical Care Medicine Springfield - Pulmonary	3300 Main Street	Springfield	MA	Active
DSH220077AL	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Cardiology Springfield - Cardiology	3300 Main Street	Springfield	MA	Active
DSH220077AM	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Mason Square Neighborhood Health Center - TB Clinic	11 Wilbraham Road	Springfield	MA	Active
DSH220077AN	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Medical Center Infusion Suite - Infusion	2 Medical Center Drive	Springfield	MA	Active
DSH220077AP	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE CHILDREN'S SPECIALTY CENTE - Pediatric Pulmonology	50 WASON AVE	SPRINGFIELD	MA	Active
DSH220077AQ	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE CHILDREN'S SPECIALTY CENTE - Pediatric Gastroenterology	50 WASON AVE	SPRINGFIELD	MA	Active
DSH220077AR	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE CHILDREN'S SPECIALTY CENTE - Pediatric Infectious Disease	50 WASON AVE	SPRINGFIELD	MA	Active
DSH220077AS	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE CHILDREN'S SPECIALTY CENTE - Pediatric Cardiology	50 WASON AVE	SPRINGFIELD	MA	Active
DSH220077AT	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE CHILDREN'S SPECIALTY CENTE - Pediatric Endocrinology	50 WASON AVE	SPRINGFIELD	MA	Active
DSH220077AU	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE CHILDREN'S SPECIALTY CENTE - Pediatric Neurology	50 WASON AVE	SPRINGFIELD	MA	Active
DSH220077AV	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE CHILDREN'S SPECIALTY CENTE - Adolescent Medicine	50 WASON AVE	SPRINGFIELD	MA	Active
DSH220077AW	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE INFUSION CENTER - PALMER - Infusion - Wing Satellite	40 WRIGHT ST	PALMER	MA	Approved
DSH220077AX	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE INFUSION CENTER NOBLE HOSP - Baystate Infusion - Noble Sat	115 W SILVER ST	WESTFIELD	MA	Approved
DSH220077B	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE BRIGHTWOOD HEALTH CENTER CENTRO DE SALUD	380 PLAINFIELD STREET	SPRINGFIELD	MA	Active
DSH220077D	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE ACUTE CARE	759 CHESTNUT STREET	SPRINGFIELD	MA	Terminated
DSH220077E	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE REGIONAL CANCER CENTER D'AMOUR CENTER FOR CANCER CARE	3350 MAIN STREET	SPRINGFIELD	MA	Active
DSH220077F	Child	DSH	BAYSTATE MEDICAL CENTER	CHESTNUT SURGICAL CENTER	759 CHESTNUT STREET	SPRINGFIELD	MA	Terminated
DSH220077G	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Orthopedic Surgery Center	50 Wason Avenue	SPRINGFIELD	MA	Terminated
DSH220077H	Child	DSH	BAYSTATE MEDICAL CENTER	BAYSTATE PAIN MANAGEMENT CENTER	3400 MAIN STREET	SPRINGFIELD	MA	Active
DSH220077L	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Mason Square Neighborhood Health Center	11 Wilbraham Rd	Springfield	MA	Active
DSH220077M	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Behavioral Health	3300 Main St.	Springfield	MA	Active
DSH220077N	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate General Pediatrics	140 High Street	Springfield	MA	Active
DSH220077P	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Midwifery & Women's Health	3300 Main St.	Springfield	MA	Active
DSH220077Q	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Vascular Services	3500 Main St.	Springfield	MA	Active
DSH220077R	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Regional Cancer Program at Baystate Mary Lane	85 South St.	Ware	MA	Terminated
DSH220077S	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Medical Center Transplant Services	100 Wason Ave.	Springfield	MA	Active
DSH220077T	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Children's Specialty Center / Baystate Medical Genetics	50 Wason Avenue	Springfield	MA	Active
DSH220077U	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Children's Specialty Center / Baystate Developmental and Behavioral Pediatrics	50 Wason Avenue	Springfield	MA	Active
DSH220077V	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Adult Partial Hospitalization	140 High St	Springfield	MA	Active
DSH220077W	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Cardiac Rehabilitation and Wellness	3300 Main Street	Springfield	MA	Active
DSH220077X	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Pulmonary Function Lab	3300 Main Street	Springfield	MA	Active
DSH220077Y	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Pulmonary Rehabilitation	3300 Main Street	Springfield	MA	Active
DSH220077Z	Child	DSH	BAYSTATE MEDICAL CENTER	Baystate Urogynecology	3300 Main Street	Springfield	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		McCarthy, Raymond P SVP, Chief Financial Officer & Treasurer Baystate Health 4137943290	4/8/2025 3:19 PM
Details	340B ID	Update	New Registration		DSH220077AX	4/8/2025 3:19 PM
Details	Entity Subname	Update	New Registration	BAYSTATE INFUSION CENTER NOBLE HOSP	BAYSTATE INFUSION CENTER NOBLE HOSP - Baystate Infusion - Noble Sat	4/8/2025 3:19 PM
Dates	Participating Approval Date	Update	New Registration		4/8/2025 3:19:59 PM	4/8/2025 3:19 PM
Details	State	Update	New Registration	Pending	Approved	4/8/2025 3:19 PM
Dates	Signed By Date	Update	New Registration		4/8/2025 7:17:54 AM	4/8/2025 3:19 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/8/2025 3:19 PM
Addresses	Main Address	Insert	New Registration		115 W SILVER ST 3RD FLOOR WESTFIELD, MA 01085-3678	4/7/2025 11:02 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/7/2025 11:02 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110020829H	4/7/2025 11:02 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	4/7/2025 11:02 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1487655064	4/7/2025 11:02 AM
Medicaid Billing	NPI: State	Insert	New Registration		MA	4/7/2025 11:02 AM
Contacts	Authorizing Official	Insert	New Registration		McCarthy, Raymond P SVP, Chief Financial Officer & Treasurer Baystate Health 4137943290	4/7/2025 11:02 AM
Contacts	Primary Contact	Insert	New Registration		Cruz, Nancy Pharmacy Compliance Manager Baystate Health 4137948282	4/7/2025 11:02 AM
Details	Assistance Received From Date	Insert	New Registration			4/7/2025 11:02 AM
Details	Assistance Received To Date	Insert	New Registration			4/7/2025 11:02 AM
Details	Last Recertification Date	Insert	New Registration			4/7/2025 11:02 AM
Details	Grant Number	Insert	New Registration			4/7/2025 11:02 AM
Details	340B ID	Insert	New Registration			4/7/2025 11:02 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/7/2025 11:02 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/7/2025 11:02 AM
Details	Medicare Provider Number	Insert	New Registration		220077	4/7/2025 11:02 AM
Details	Entity Name	Insert	New Registration		BAYSTATE MEDICAL CENTER	4/7/2025 11:02 AM
Details	NOFO Number	Insert	New Registration			4/7/2025 11:02 AM
Details	Program Code	Insert	New Registration		DSH	4/7/2025 11:02 AM
Details	Entity Subname	Insert	New Registration		BAYSTATE INFUSION CENTER NOBLE HOSP	4/7/2025 11:02 AM
Dates	Participating Approval Date	Insert	New Registration			4/7/2025 11:02 AM
Details	State	Insert	New Registration		Pending	4/7/2025 11:02 AM
Dates	Registration Date	Insert	New Registration		4/7/2025 11:02:10 AM	4/7/2025 11:02 AM
Dates	Signed By Date	Insert	New Registration			4/7/2025 11:02 AM
Dates	Start Date	Insert	New Registration			4/7/2025 11:02 AM
Terminations	Termination Comments	Insert	New Registration			4/7/2025 11:02 AM
Terminations	Termination Date	Insert	New Registration			4/7/2025 11:02 AM
Terminations	Termination Effective Date	Insert	New Registration			4/7/2025 11:02 AM
Terminations	Termination Reason	Insert	New Registration			4/7/2025 11:02 AM