Covered Entity Details

DSH220024P HOLYOKE MEDICAL CENTER (Terminated) - information as of 6/25/2025 12:57:15 AM

Main Details

Name

HOLYOKE MEDICAL CENTER

Subdivision Name

HMC ORTHOPEDIC SURGEONS - Orthopedic Center / Chicopee

Type

Disproportionate Share Hospital

Rural

340B ID

DSH220024P

Medicare Provider Number

220024

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/13/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/25/2020

Last Recertification Date

Termination Date
Termination Reason

10/1/2020
Business decision by the Covered Entity

Contacts

Authorizing Official

Holyoke Medical Center
SPIROS HATIRAS, CEO
(413) 534-2667

Primary Contact

Holyoke Medical Center
Paul J Barrett, Director of Pharmacy
(413) 534-2757

Addresses

Street Address

1962 Memorial Drive
Holyoke
Chicopee, MA 01020

Billing Address

Holyoke Medical Center
575 Beech Street
Holyoke, MA 01040

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	110026773B

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
DSH220024A	Child	DSH	HOLYOKE MEDICAL CENTER	HMC WOUND CARE CENTER	18 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024AA	Child	DSH	HOLYOKE MEDICAL CENTER	NEUROLOGY AND SLEEP/SPRINGFIELD - SLEEP MANAGEMENT	2150 MAIN STREET	SPRINGFIELD	MA	Active
DSH220024AB	Child	DSH	HOLYOKE MEDICAL CENTER	HMC SPINE CENTER - SPINE CENTER	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024AC	Child	DSH	HOLYOKE MEDICAL CENTER	RVCC/HOLYOKE HIGH SCHOOL SULLIVAN - HIGH SCHOOL	400 JARVIS AVENUE	HOLYOKE	MA	Active
DSH220024AD	Child	DSH	HOLYOKE MEDICAL CENTER	RVCC/HOLYOKE HIGH SCHOOL NORTH - HIGH SCHOOL	500 BEECH STREET	HOLYOKE	MA	Active
DSH220024AE	Child	DSH	HOLYOKE MEDICAL CENTER	RVCC/HOLYOKE HIGH SCHOOL DEAN CAMPUS - HIGH SCHOOL	1045 MAIN STREET	HOLYOKE	MA	Active
DSH220024AF	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Kidney Associates-Maple St - KIDNEY ASSOCIATES	230 MAPLE STREET	HOLYOKE	MA	Active
DSH220024AG	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Kidney Associates - Enfield - KIDNEY ASSOCIATES	115 ELM STREET	ENFIELD	CT	Active
DSH220024AH	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Kidney Associates-Springfield - KIDNEY ASSOCIATES	2150 MAIN STREET	SPRINGFIELD	MA	Active
DSH220024AJ	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Walk In Care- Westfield - WALK IN CARE	140 SOUTHAMPTON ROAD	WESTFIELD	MA	Active
DSH220024AK	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Pediatric Care - PEDIATRIC CARE	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024AL	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Kidney Associates-Holyoke - KIDNEY ASSOCIATES	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024AM	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Family Medicine - FAMILY MEDICINE	140 SOUTHAMPTON ROAD	WESTFIELD	MA	Active
DSH220024AN	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Adult Primary Care- Holyoke - Primary Care	2 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024AP	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Adult Primary Care- Chicopee - Primary Care	1962 MEMORIAL DRIVE	CHICOPEE	MA	Active
DSH220024AQ	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Walk In Care- Chicopee - WALK IN CARE	1962 MEMORIAL DRIVE	CHICOPEE	MA	Active
DSH220024B	Child	DSH	HOLYOKE MEDICAL CENTER	HMC GENERAL SURGEONS	11 HOSPITAL DRIVE, 3RD FLOOR	HOLYOKE	MA	Active
DSH220024C	Child	DSH	HOLYOKE MEDICAL CENTER	HMC ORTHOPEDIC SURGEONS	10 HOSPITAL DR	HOLYOKE	MA	Terminated
DSH220024D	Child	DSH	HOLYOKE MEDICAL CENTER	HMC SPECIALTY SURGEONS	11 HOSPITAL DRIVE, 3RD FLOOR	HOLYOKE	MA	Active
DSH220024E	Child	DSH	HOLYOKE MEDICAL CENTER	HMC ENDOCRINOLOGY & DIABETES CENTER	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024F	Child	DSH	HOLYOKE MEDICAL CENTER	HMC RHEUMATOLOGY	575 Beech Street	HOLYOKE	MA	Terminated
DSH220024G	Child	DSH	HOLYOKE MEDICAL CENTER	HMC Urology	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024H	Child	DSH	HOLYOKE MEDICAL CENTER	Gastroenterology - Gastroenterology	11 Hospital Drive	Holyoke	MA	Terminated
DSH220024J	Child	DSH	HOLYOKE MEDICAL CENTER	Weight Management Program - Bariatric Surgeon	11 HOSPITAL DRIVE, 3RD FLOOR	HOLYOKE	MA	Active
DSH220024K	Child	DSH	HOLYOKE MEDICAL CENTER	Vascular Center - Vascular Surgery	2 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024L	Child	DSH	HOLYOKE MEDICAL CENTER	Pulmonology Center - Respiratory Therapy	5 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024M	Child	DSH	HOLYOKE MEDICAL CENTER	HMC GASTROENTEROLOGY - Gastroenterology / Westfield	94 N Elm Street	Westfield	MA	Terminated
DSH220024N	Child	DSH	HOLYOKE MEDICAL CENTER	HMC GASTROENTEROLOGY - Gastroenterology / Holyoke	11 HOSPITAL DRIVE, 3RD FLOOR	HOLYOKE	MA	Active
DSH220024P	Child	DSH	HOLYOKE MEDICAL CENTER	HMC ORTHOPEDIC SURGEONS - Orthopedic Center / Chicopee	1962 Memorial Drive	Chicopee	MA	Terminated
DSH220024Q	Child	DSH	HOLYOKE MEDICAL CENTER	HMC CARDIOVASCULAR SPECIALISTS - Cardiovascular Specialists / Holyoke	11 HOSPITAL DRIVE, 3RD FLOOR	HOLYOKE	MA	Active
DSH220024R	Child	DSH	HOLYOKE MEDICAL CENTER	HMC ORTHOPEDIC SURGEONS - Orthopedic Center / Holyoke	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024S	Child	DSH	HOLYOKE MEDICAL CENTER	HMC DEPARTMENT OF UROLOGY - Urology Center / Springfield	100 WASON AVE 240	SPRINGFIELD	MA	Terminated
DSH220024T	Child	DSH	HOLYOKE MEDICAL CENTER	HMC CARDIOVASCULAR SPECIALISTS - Cardiovascular Specialists / Chicopee	1962 Memorial Drive	Chicopee	MA	Terminated
DSH220024U	Child	DSH	HOLYOKE MEDICAL CENTER	HMC - Pain Management Center	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024V	Child	DSH	HOLYOKE MEDICAL CENTER	HOLYOKE MEDICAL CENTER, INC. - Gastroenterology / Westfield	140 SOUTHAMPTON RD	WESTFIELD	MA	Active
DSH220024W	Child	DSH	HOLYOKE MEDICAL CENTER	HMC WOMEN SERVICES - OB/GYN & Midwifery	575 Beech Street	Holyoke	MA	Active
DSH220024X	Child	DSH	HOLYOKE MEDICAL CENTER	HMC RHEUMATOLOGY - RHEUMATOLOGY	10 HOSPITAL DRIVE	HOLYOKE	MA	Active
DSH220024Y	Child	DSH	HOLYOKE MEDICAL CENTER	HMC WOMEN SERVICES - OB/GYN & Midwifery / Maple St	230 Maple Street	Holyoke	MA	Active
DSH220024Z	Child	DSH	HOLYOKE MEDICAL CENTER	Partial Hospital Program & Intensive Outpatient Program - PSYCH	20 HOSPITAL DRIVE	HOLYOKE	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		10/1/2020 12:00:00 AM	9/4/2020 11:58 PM
Details	State	Update	Recertification	Active	To Be Terminated	9/4/2020 11:58 PM
Terminations	Termination Comments	Update	Recertification		Closed clinic	9/4/2020 11:58 PM
Terminations	Termination Date	Update	Recertification		10/1/2020 12:00:00 AM	9/4/2020 11:58 PM
Terminations	Termination Effective Date	Update	Recertification		10/1/2020 12:00:00 AM	9/4/2020 11:58 PM
Terminations	Termination Reason	Update	Recertification		Business decision by the Covered Entity	9/4/2020 11:58 PM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		HATIRAS, SPIROS CEO Holyoke Medical Center 4135342667	2/25/2020 3:02 PM
Details	340B ID	Update	New Registration		DSH220024P	2/25/2020 3:02 PM
Details	Entity Subname	Update	New Registration	HMC ORTHOPEDIC SURGEONS	HMC ORTHOPEDIC SURGEONS - Orthopedic Center / Chicopee	2/25/2020 3:02 PM
Dates	Participating Approval Date	Update	New Registration		2/25/2020 3:02:45 PM	2/25/2020 3:02 PM
Details	State	Update	New Registration	Pending	Approved	2/25/2020 3:02 PM
Dates	Signed By Date	Update	New Registration		1/14/2020 10:51:52 AM	2/25/2020 3:02 PM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/25/2020 3:02 PM
Addresses	Main Address	Insert	New Registration		1962 Memorial Drive Holyoke Chicopee, MA 01020	1/13/2020 1:35 PM
Addresses	Billing Address	Insert	New Registration		Holyoke Medical Center 575 Beech Street Holyoke, MA 01040	1/13/2020 1:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/13/2020 1:35 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110026773B	1/13/2020 1:35 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	1/13/2020 1:35 PM
Contacts	Authorizing Official	Insert	New Registration		HATIRAS, SPIROS CEO Holyoke Medical Center 4135342667	1/13/2020 1:35 PM
Contacts	Primary Contact	Insert	New Registration		Barrett, Paul J Director of Pharmacy Holyoke Medical Center 4135342757	1/13/2020 1:35 PM
Details	Last Recertification Date	Insert	New Registration			1/13/2020 1:35 PM
Details	Grant Number	Insert	New Registration			1/13/2020 1:35 PM
Details	340B ID	Insert	New Registration			1/13/2020 1:35 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2020 1:35 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2020 1:35 PM
Details	Medicare Provider Number	Insert	New Registration		220024	1/13/2020 1:35 PM
Details	Entity Name	Insert	New Registration		HOLYOKE MEDICAL CENTER	1/13/2020 1:35 PM
Details	Program Code	Insert	New Registration		DSH	1/13/2020 1:35 PM
Details	Entity Subname	Insert	New Registration		HMC ORTHOPEDIC SURGEONS	1/13/2020 1:35 PM
Dates	Participating Approval Date	Insert	New Registration			1/13/2020 1:35 PM
Details	State	Insert	New Registration		Pending	1/13/2020 1:35 PM
Dates	Registration Date	Insert	New Registration		1/13/2020 1:35:28 PM	1/13/2020 1:35 PM
Dates	Signed By Date	Insert	New Registration			1/13/2020 1:35 PM
Dates	Start Date	Insert	New Registration			1/13/2020 1:35 PM
Terminations	Termination Comments	Insert	New Registration			1/13/2020 1:35 PM
Terminations	Termination Date	Insert	New Registration			1/13/2020 1:35 PM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2020 1:35 PM
Terminations	Termination Reason	Insert	New Registration			1/13/2020 1:35 PM