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CVS PHARMACY, INC.
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
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 02071
400 BEECH ST.
HOLYOKE, MA 01040
Pharmacy Comments
Contract Details
Approval Date
1/16/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SPIROS HATIRAS, CEO
(413) 534-2667
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/16/2017
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