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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 # 01026
991 MAIN STREET
SPRINGFIELD, MA 01103
Pharmacy Comments
Contract Details
Approval Date
1/14/2013
Contract Begin Date
1/14/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis Chalke, Chief Financial Officer
(413) 794-3290
Contract Pharmacy Representative
Scott Tierney, Senior Director, Payer Relations
(401) 770-2762
Signed By Date
1/4/2013
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