Covered Entity Details

DSH220016A BAYSTATE FRANKLIN MEDICAL CENTER (Active) - information as of 4/26/2025 11:41:08 PM

Main Details

Name

BAYSTATE FRANKLIN MEDICAL CENTER

Subdivision Name

Wound Care / Hyperbaric Medicine Center Greenfield

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH220016A

Medicare Provider Number

220016

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/5/2016

Participating Start Date

1/1/2017

Participating Approval Date

11/2/2016

Last Recertification Date

8/12/2024

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

48 Sanderson St
First Floor
Greenfield, MA 01301

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	110024350C	1508867391

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
DSH220016A	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Wound Care / Hyperbaric Medicine Center Greenfield	48 Sanderson St	Greenfield	MA	Active
DSH220016B	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Behavioral Health Adult Partial Hospitalization Program	157 High Street	Greenfield	MA	Active
DSH220016C	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Sleep Medicine Greenfield - Sleep Medicine	48 Sanderson Street	Greenfield	MA	Active
DSH220016D	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Midwifery, OBGYN, & Urogynecology Greenfield - Midwifery, OBGYN, Urogynecology	48 Sanderson Street	Greenfield	MA	Active
DSH220016E	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Surgery & Infectious Disease Greenfield - General Surgery & Infectious Disease	48 Sanderson Street	Greenfield	MA	Active
DSH220016F	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Plastic Surgery Greenfield - Surgery	48 Sanderson Street	Greenfield	MA	Active
DSH220016G	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Breast Specialists Greenfield - Breast Specialists	48 Sanderson Street	Greenfield	MA	Active
DSH220016H	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Gastroenterology Greenfield - Gastroenterology	48 Sanderson Street	Greenfield	MA	Active
DSH220016J	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Family Medicine Greenfield - Family Medicine	48 Sanderson Street	Greenfield	MA	Active
DSH220016K	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Urology Greenfield - Urology	48 Sanderson Street	Greenfield	MA	Active
DSH220016L	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Neurology Greenfield - Neurology	48 Sanderson Street	Greenfield	MA	Active
DSH220016M	Child	DSH	BAYSTATE FRANKLIN MEDICAL CENTER	Baystate Integrated Behavioral Health Greenfield - Behavioral Health	48 Sanderson Street	Greenfield	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/15/2023 5:18:56 PM	8/12/2024 11:03:43 AM	8/12/2024 11:03 AM
Details	Last Recertification Date	Update	Recertification	8/31/2022 2:46:36 PM	8/15/2023 5:18:56 PM	8/15/2023 5:18 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	3023579 (CO)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	914232100 (FL)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	METPID004698 (ME)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003023579 (CT)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	3087479 (NH)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	03010271 (NY)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0220016 (VT)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003129369A (GA)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	11805B (SC)		4/12/2023 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	200813430A (IN)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (CT)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (GA)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (VT)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (NY)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (SC)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (ME)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (IN)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (NH)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (FL)		4/12/2023 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1508867391 (CO)		4/12/2023 8:15 AM
Contacts	Primary Contact	Update	Change Request	kerr, gary j. chief pharmacy officer baystate health 4137943178	Cruz, Nancy Pharmacy Compliance Manager Baystate Health 4137948282	10/19/2022 12:54 PM
Details	Last Recertification Date	Update	Recertification	8/16/2021 8:33:33 AM	8/31/2022 2:46:36 PM	8/31/2022 2:46 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 3:24:31 PM	8/16/2021 8:33:33 AM	8/16/2021 8:33 AM
Contacts	Authorizing Official	Update	Profile Change Request	McCarthy, Raymond P Interim CFO Baystate Health 4137947944	McCarthy, Raymond P SVP, Chief Financial Officer & Treasurer Baystate Health 4137943290	8/3/2021 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3023579	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CO	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		914232100	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		METPID004698	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	1/26/2021 2:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	144990000 (ME)		1/26/2021 2:35 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	910755000 (FL)		1/26/2021 2:35 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1508867391	1/26/2021 2:35 PM
Medicaid Billing	NPI: State	Insert	Change Request		CO	1/26/2021 2:35 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		CT	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		GA	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		VT	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		NY	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		MA	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		SC	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		ME	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		IN	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		NH	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1508867391	9/10/2020 3:24 PM
Medicaid Billing	NPI: State	Insert	Recertification		FL	9/10/2020 3:24 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1508867391 ( )		9/10/2020 3:24 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 9:53:30 AM	9/10/2020 3:24:31 PM	9/10/2020 3:24 PM
Contacts	Authorizing Official	Update	AO Change Request	Chalke, Dennis Sr. VP Finance & Community Hospitals/CFO & Treasurer Baystate Health 4137943290	McCarthy, Raymond P Interim CFO Baystate Health 4137947944	2/25/2020 9:29 AM
Details	Last Recertification Date	Update	Recertification	8/23/2018 2:26:01 PM	8/28/2019 9:53:30 AM	8/28/2019 9:53 AM
Details	Last Recertification Date	Update	Recertification	11/30/2017 3:52:00 PM	8/23/2018 2:26:01 PM	8/23/2018 2:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/27/2018 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200813430A	4/27/2018 10:59 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	4/27/2018 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/27/2018 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110024350C	4/27/2018 10:59 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	4/27/2018 10:59 AM
Details	Last Recertification Date	Update	Recertification		11/30/2017 3:52:00 PM	11/30/2017 3:52 PM
Contacts	Authorizing Official	Update		Chalke, Dennis Sr. VP Finance & Community Hospitals/CFO & Treasurer 4137943290	Chalke, Dennis Sr. VP Finance & Community Hospitals/CFO & Treasurer Baystate Health 4137943290	10/13/2017 10:42 AM
Contacts	Signed By	Update		Chalke, Dennis Sr. VP Finance & Community Hospitals/CFO & Treasurer 4137943290	Chalke, Dennis Sr. VP Finance & Community Hospitals/CFO & Treasurer Baystate Health 4137943290	10/13/2017 10:42 AM
Contacts	Primary Contact	Update		kerr, gary j. chief pharmacy officer 4137943178	kerr, gary j. chief pharmacy officer baystate health 4137943178	10/11/2017 2:50 PM
Contacts	Primary Contact	Insert			kerr, gary j. chief pharmacy officer 4137943178	8/10/2017 3:37 PM
Contacts	Authorizing Official	Insert			Chalke, Dennis Sr. VP Finance & Community Hospitals/CFO & Treasurer 4137943290	8/10/2017 3:37 PM
Contacts	Signed By	Insert			Chalke, Dennis Sr. VP Finance & Community Hospitals/CFO & Treasurer 4137943290	8/10/2017 3:37 PM
Addresses	Main Address	Insert			48 Sanderson St First Floor Greenfield, MA 01301	8/10/2017 3:37 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/10/2017 3:36 PM
Medicaid Billing	Medicaid: Number	Insert			11805B	8/10/2017 3:36 PM
Medicaid Billing	Medicaid: State	Insert			SC	8/10/2017 3:36 PM
Dates	Participating Approval Date	Update			11/2/2016 12:00:00 AM	11/2/2016 3:27 PM
Details	State	Update		Pending	Active	11/2/2016 3:27 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	11/2/2016 3:27 PM
Details	Entity Subname	Update		Wound Care and Hyperbaric Medicine Greenfield / Wound Care and Hyperbaric Medicine Center Greenfield	Wound Care / Hyperbaric Medicine Center Greenfield	11/1/2016 3:19 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_72441	DSH220016A	10/28/2016 8:10 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_72441	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Number	Insert			003023579	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: State	Insert			CT	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Number	Insert			144990000	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: State	Insert			ME	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Number	Insert			3087479	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: State	Insert			NH	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Number	Insert			03010271	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: State	Insert			NY	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Number	Insert			0220016	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: State	Insert			VT	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Number	Insert			910755000	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: State	Insert			FL	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: Number	Insert			003129369A	10/5/2016 10:39 AM
Medicaid Billing	Medicaid: State	Insert			GA	10/5/2016 10:39 AM
Medicaid Billing	NPI: Number	Insert			1508867391	10/5/2016 10:39 AM
Details	Last Recertification Date	Insert				10/5/2016 10:39 AM
Details	Grant Number	Insert				10/5/2016 10:39 AM
Details	340B ID	Insert				10/5/2016 10:39 AM
Details	Is Authorizing Official EHB Data	Insert				10/5/2016 10:39 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/5/2016 10:39 AM
Details	Medicare Provider Number	Insert			220016	10/5/2016 10:39 AM
Details	Entity Name	Insert			BAYSTATE FRANKLIN MEDICAL CENTER	10/5/2016 10:39 AM
Details	Program Code	Insert			DSH	10/5/2016 10:39 AM
Details	Entity Subname	Insert			Wound Care and Hyperbaric Medicine Greenfield / Wound Care and Hyperbaric Medicine Center Greenfield	10/5/2016 10:39 AM
Dates	Participating Approval Date	Insert				10/5/2016 10:39 AM
Details	State	Insert			Pending	10/5/2016 10:39 AM
Dates	Registration Date	Insert			10/5/2016 12:00:00 AM	10/5/2016 10:39 AM
Dates	Signed By Date	Insert			10/5/2016 12:00:00 AM	10/5/2016 10:39 AM
Dates	Start Date	Insert				10/5/2016 10:39 AM
Terminations	Termination Comments	Insert				10/5/2016 10:39 AM
Terminations	Termination Date	Insert				10/5/2016 10:39 AM
Terminations	Termination Effective Date	Insert				10/5/2016 10:39 AM
Terminations	Termination Reason	Insert				10/5/2016 10:39 AM