Contract Pharmacy Details

CVS PHARMACY, INC.
DSH220016 BAYSTATE FRANKLIN MEDICAL CENTER

Covered Entity Details

Entity Name

BAYSTATE FRANKLIN MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH220016

Entity Address

164 HIGH STREET
GREENFIELD, MA 01301

Medicare Provider Number

220016

Participating Start Date

4/1/2009

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 01094
137 FEDERAL STREET
GREENFIELD, MA 01301

Pharmacy Comments

Contract Details

Approval Date

1/17/2013

Contract Begin Date

1/17/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/21/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Chuck Gijanto, President
(413) 773-2611

Contract Pharmacy Representative

Scott Tierney, Senior Director, Payer Relations
(401) 770-2762

Signed By Date

1/3/2013

340B Drug Pricing Program Database