Contract Pharmacy Details

CORAM HEALTHCARE CORPORATION OF MASSACHU
DSH220024 HOLYOKE MEDICAL CENTER

Covered Entity Details

Entity Name

HOLYOKE MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220024

Entity Address

575 BEECH STREET
HOLYOKE, MA 01040

Medicare Provider Number

220024

Participating Start Date

10/1/2004

Last Recertification Date

8/20/2024

Pharmacy Details

Pharmacy Name

CORAM HEALTHCARE CORPORATION OF MASSACHU

Pharmacy Address

CORAM CVS/SPECIALTY INFUSION SERVICES
575 UNIVERSITY AVENUE
SUITE 2
NORWOOD, MA 02062

Pharmacy Comments

Contract Details

Approval Date

10/8/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/17/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

SPIROS HATIRAS, CEO
(413) 534-2667

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/8/2019

340B Drug Pricing Program Database