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CVS PHARMACY, INC.
DSH220077 BAYSTATE MEDICAL CENTER
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Covered Entity Details
Entity Name
BAYSTATE MEDICAL CENTER
Subdivision Name
BAYSTATE NORTH CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH220077
Entity Address
759 CHESTNUT STREET
SPRINGFIELD, MA 01199
Medicare Provider Number
220077
Participating Start Date
7/1/2003
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 00127
110 FRONT ST., SUITE #102
WORCESTER, MA 01608
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/1/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Raymond P McCarthy, SVP, Chief Financial Officer & Treasurer
(413) 794-3290
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
4/14/2020
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