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DSH220077B BAYSTATE MEDICAL CENTER (Active)
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Main Details
Name
BAYSTATE MEDICAL CENTER
Subdivision Name
BAYSTATE BRIGHTWOOD HEALTH CENTER CENTRO DE SALUD
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220077B
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
380 PLAINFIELD STREET
SPRINGFIELD, MA 01107
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. 3/7/12 NAME CAHNGE FROM BRIGHTWOOD/RIVERVIEW HLTH CTR. 10/7/04 REMOVED MEDICAID # (WAS 0445401)
06/28/2012
10/7/04 REMOVED MEDICAID # (WAS 0445401)
04/23/2008
3/7/12 NAME CAHNGE FROM BRIGHTWOOD/RIVERVIEW HLTH CTR 10/7/04 REMOVED MEDICAID # (WAS 0445401)
04/23/2008
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