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GENOA HEALTHCARE LLC
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
GENOA HEALTHCARE LLC
Pharmacy Address
12 QUEEN ST RM 129
WORCESTER, MA 01610
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
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
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/12/2023
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