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DSH220077 BAYSTATE MEDICAL CENTER (Active)
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Main Details
Name
BAYSTATE MEDICAL CENTER
Subdivision Name
BAYSTATE NORTH CAMPUS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220077
Medicare Provider Number
220077
Additional Details
Current Program Status
Active
Registration Date
4/23/2008
Participating Start Date
7/1/2003
Participating Approval Date
4/23/2008
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
759 CHESTNUT STREET
SPRINGFIELD, MA 01199
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/7/04 REMOVED MEDICAID # (WAS 0445355)
01/13/2010
2/27/12 ADD ADDITIONAL SHIPPING ADDRESS 10/7/04 REMOVED MEDICAID # (WAS 0445355)
04/23/2008
May 2025
May 2025
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