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CONNECTICUT CVS PHARMACY, L.L.C.
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
CONNECTICUT CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02109
22 WINDSOR AVE
VERNON ROCKVILLE, CT 06066
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Raymond P McCarthy, SVP, Chief Financial Officer & Treasurer
(413) 794-3290
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2021
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