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CVS PHARMACY, INC.
DSH220065 BAYSTATE NOBLE HOSPITAL
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Covered Entity Details
Entity Name
BAYSTATE NOBLE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220065
Entity Address
115 WEST SILVER STREET
WESTFIELD, MA 01086
Medicare Provider Number
220065
Participating Start Date
7/1/2019
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 00950
410 LONGMEADOW STREET
LONGMEADOW, MA 01106
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/17/2022
Business decision by covered entity and/or pharmacy
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
4/15/2020
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