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DSH220077F BAYSTATE MEDICAL CENTER (Terminated)
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Main Details
Name
BAYSTATE MEDICAL CENTER
Subdivision Name
CHESTNUT SURGICAL CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220077F
Medicare Provider Number
220077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/23/2008
Participating Start Date
10/1/2003
Participating Approval Date
4/23/2008
Last Recertification Date
9/2/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Baystate Health
Raymond P McCarthy, SVP, Chief Financial Officer & Treasurer
(413) 794-3290
Primary Contact
baystate health
gary j. kerr, chief pharmacy officer
(413) 794-3178
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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