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DSH220077R BAYSTATE MEDICAL CENTER (Terminated)
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Main Details
Name
BAYSTATE MEDICAL CENTER
Subdivision Name
Baystate Regional Cancer Program at Baystate Mary Lane
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220077R
Medicare Provider Number
220077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/11/2013
Last Recertification Date
9/10/2020
Termination Date
Termination Reason
10/1/2021
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
85 South St.
Ware, MA 01082
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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