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DSH220077A BAYSTATE MEDICAL CENTER (Active)
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Main Details
Name
BAYSTATE MEDICAL CENTER
Subdivision Name
BAYSTATE HIGH STREET HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220077A
Medicare Provider Number
220077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/23/2008
Participating Start Date
7/1/2012
Participating Approval Date
6/28/2012
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
140 HIGH STREET
C-Level
SPRINGFIELD, MA 01105
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/28/12 Entity reinstated eff. 7/1/12; was ineligible from 4/1/12 through 6/30/12. 10/28/08 UPDATED SUBDIV NAME (WAS BAYSTATE PHARMACY SOUTH CAMPUS); 10/28/08 ADDED MEDICAID #; 10/7/04 REMOVED MEDICAID # (WAS 0445266)
06/28/2012
10/28/08 UPDATED SUBDIV NAME (WAS BAYSTATE PHARMACY SOUTH CAMPUS); 10/28/08 ADDED MEDICAID #; 10/7/04 REMOVED MEDICAID # (WAS 0445266)
04/23/2008
April 2025
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