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DSH220077AU BAYSTATE MEDICAL CENTER (Active)
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Main Details
Name
BAYSTATE MEDICAL CENTER
Subdivision Name
BAYSTATE CHILDREN'S SPECIALTY CENTE - Pediatric Neurology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220077AU
Medicare Provider Number
220077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/3/2021
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
50 WASON AVE
SPRINGFIELD, MA 01107-1132
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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