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WAL-MART PHARMACY 10-1967
DSH220024 HOLYOKE MEDICAL CENTER
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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
WAL-MART PHARMACY 10-1967
Pharmacy Address
1105 BOSTON ROAD
SPRINGFIELD, MA 01119
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SPIROS HATIRAS, CEO
(413) 534-2667
Contract Pharmacy Representative
Walmart
Craig Smith, RPh.
(479) 903-5739
Signed By Date
1/14/2020
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