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SPRINGFIELD PHARMACY LLC
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
SPRINGFIELD PHARMACY LLC
Pharmacy Address
2547 MAIN ST STE 105
SPRINGFIELD, MA 01107-1935
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SPIROS HATIRAS, CEO
(413) 534-2667
Contract Pharmacy Representative
Springfield Pharmacy
alexander wu, Owner
(203) 751-3961
Signed By Date
4/15/2021
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