Contract Pharmacy Details

MAXI DRUG, INC.
DSH220077 BAYSTATE MEDICAL CENTER

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

MAXI DRUG, INC.

Pharmacy Address

RITE AID #10060
7 EAST SILVER STREET
WESTFIELD, MA 01085

Pharmacy Comments

Contract Details

Approval Date

1/15/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/30/2018
Ownership change

Contacts

Covered Entity Signing Official

Dennis Chalke, Sr. VP Finance & Community Hospitals/CFO & Treasurer
(413) 794-3290

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

1/15/2014

340B Drug Pricing Program Database