340B Drug Pricing Program Database
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DSH220077AD BAYSTATE MEDICAL CENTER (Active)
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Main Details
Name
BAYSTATE MEDICAL CENTER
Subdivision Name
Baystate Breast and Wellness Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220077AD
Medicare Provider Number
220077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/9/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/11/2017
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
100 Wason Avenue
Suite 300
Springfield, MA 01107
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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