Covered Entity Details

DSH220074CW SOUTHCOAST HOSPITALS GROUP, INC (Active) - information as of 6/14/2025 10:11:08 AM

Main Details

Name

SOUTHCOAST HOSPITALS GROUP, INC

Subdivision Name

Fall River Endocrine Clinic - Endocrine

Type

Disproportionate Share Hospital

Rural

340B ID

DSH220074CW

Medicare Provider Number

220074

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/11/2024

Participating Start Date

4/1/2024

Participating Approval Date

2/5/2024

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

Southcoast Health
Renee Clark, Exec. Vice President & Chief Operating Officer
(508) 973-5872

Primary Contact

Southcoast Health
Donald Dean, Pharmacy Director
(508) 973-3022

Addresses

Street Address

235 Hanover St
Fall River, MA 02720

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
RI	1306871223	1306871223
MA	110022082H	1306871223

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH220074A	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	Southcoast Center for Cancer Care in Fairhaven	206 MILL ROAD	FAIRHAVEN	MA	Terminated
DSH220074AA	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	ST. LUKE'S HOSPITAL / SLH - TOTAL JOINT REPLACEMENT PROGRAM	101 PAGE ST	NEW BEDFORD	MA	Terminated
DSH220074AB	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	ST. LUKE'S HOSPITAL / SLH - ANESTHESIA	101 PAGE ST	NEW BEDFORD	MA	Terminated
DSH220074AC	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - Emergency Dept.	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AD	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - WOUND CARE/OSTOMY	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AE	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH -OUTPATIENT INFUSION CENTER	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AF	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH-EEG	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AG	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - INTERVENTIONAL RADIOLOGY	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AH	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH X-RAY	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AJ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH -MAMMOGRAPHY	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AK	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - ULTRASOUND	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AL	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - NUCLEAR MEDICINE	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AM	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - CT SCAN	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AN	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - Cardiac Cath Lab	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AP	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH -RESPIRATORY THERAPY	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AQ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - PULMONARY FUNCTION TEST LAB	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AR	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - CARDIAC PULMONARY REHAB	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AS	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - EKG	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AT	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - ECHO	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AU	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH WILKS I & II Med-Surg Telemetry / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AV	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH SURG INTENSIVE CARE / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AW	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH PROGRESSIVE CARE I/II / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AX	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH NEWBORN NURSERY / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AY	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH OR/CCU OVERFLOW / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074AZ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH MED SURG TELEMETRY/BOURNE I & II / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074B	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	Southcoast Center for Cancer Care in Fall River - ONCOLOGY CLINIC	506 Prospect Street	FALL RIVER	MA	Terminated
DSH220074BA	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH Pediatrics / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BB	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH KNOWLES SURG STEPDOWN / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BC	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH SURGERY KNOWLES I & II / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BD	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH INTENSIVE CARE / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BE	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH Oncology Medical and Palliative I & II / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BF	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH CORONARY CARE UNIT / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BG	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH Orthopedics Century / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BH	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH POSTPARTUM / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BJ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH Medicine /CENTURY 4 A & 4B / Observation	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BK	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - Pre-admission Testing	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BL	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH NEWBORN NURSERY	43 HIGH ST	WAREHAM	MA	Active
DSH220074BM	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - Observation - SLH L&D/TRIAGE	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BN	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - MRI - TOH MRI	43 HIGH ST	WAREHAM	MA	Active
DSH220074BP	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - EKG - TOH ECHO	43 HIGH ST	WAREHAM	MA	Active
DSH220074BQ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - RADIOLOGY - DIAGNOSTIC - TOH X-RAY	43 HIGH ST	WAREHAM	MA	Active
DSH220074BR	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH POSTPARTUM	43 HIGH ST	WAREHAM	MA	Active
DSH220074BS	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST CENTER FOR CANCER CARE - ONCOLOGY CLINIC - CC5 Med Oncology FR	506 Prospect Street	Fall River	MA	Active
DSH220074BT	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - ASC (NON-DISTINCT PART) - TOH PERIOP SERVICES	43 HIGH ST	WAREHAM	MA	Active
DSH220074BU	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - Observation - SLH L&D/NUR/L2 PROCED	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BV	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH OP INFUSION CENTER	43 HIGH ST	WAREHAM	MA	Active
DSH220074BW	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - Observation - SLH LEVEL II NURSERY	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074BX	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - ASC (NON-DISTINCT PART) - TOH PACU	43 HIGH ST	WAREHAM	MA	Active
DSH220074BY	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - EMERGENCY - TOH Emergency Dept.	43 HIGH ST	WAREHAM	MA	Active
DSH220074BZ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	SOUTHCOAST CENTER FOR CANCER CARE - EKG - CC5 MultiDS FR	506 Prospect Street	Fall River	MA	Terminated
DSH220074C	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	DBA CHARLTON MEMORIAL HOSPITAL	363 HIGHLAND AVE.	FALL RIVER	MA	Terminated
DSH220074CA	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - RADIOISOTOPE - TOH NUCLEAR MEDICINE	43 HIGH ST	WAREHAM	MA	Active
DSH220074CB	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH SK2 GROUP I & II	43 HIGH ST	WAREHAM	MA	Active
DSH220074CC	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST CENTER FOR CANCER CARE - ONCOLOGY CLINIC - CC5 Rad Oncology FR	506 Prospect Street	Fall River	MA	Active
DSH220074CD	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH L&D/NUR PROCED	43 HIGH ST	WAREHAM	MA	Active
DSH220074CE	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - EKG - TOH EKG	43 HIGH ST	WAREHAM	MA	Active
DSH220074CF	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - RADIOLOGY - DIAGNOSTIC - TOH MAMMOGRAPHY	43 HIGH ST	WAREHAM	MA	Active
DSH220074CG	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH SK3	43 HIGH ST	WAREHAM	MA	Active
DSH220074CH	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	TOBEY HOSPITAL - EEG - TOH EEG	43 HIGH ST	WAREHAM	MA	Terminated
DSH220074CJ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - CAT SCAN - TOH CT SCAN	43 HIGH ST	WAREHAM	MA	Active
DSH220074CK	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH ICU	43 HIGH ST	WAREHAM	MA	Active
DSH220074CL	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - PHYSICAL THERAPY - TOH CARDIAC PULM REHAB	43 HIGH ST	WAREHAM	MA	Active
DSH220074CM	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - RESPIRATORY THERAPY - TOH RESPIRATORY THER	43 HIGH ST	WAREHAM	MA	Active
DSH220074CN	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - RADIOLOGY - DIAGNOSTIC - TOH ULTRASOUND	43 HIGH ST	WAREHAM	MA	Active
DSH220074CP	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH L&D/TRIAGE	43 HIGH ST	WAREHAM	MA	Active
DSH220074CQ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - ASC (NON-DISTINCT PART) - TOH PAT	43 HIGH ST	WAREHAM	MA	Active
DSH220074CR	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	TOBEY HOSPITAL - Observation - TOH BARTH UNIT	43 HIGH ST	WAREHAM	MA	Active
DSH220074CS	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - WOUND CARE - Wound Care Clinic	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074CT	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	Southcoast Rheumatology Clinic - Rheumatology	206 Mill Rd	Fairhaven	MA	Active
DSH220074CU	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL - SLH MRI	101 Page St	New Bedford	MA	Active
DSH220074CV	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	Fall River Rheumatology Clinic - Rheumatology	235 Hanover St	Fall River	MA	Active
DSH220074CW	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	Fall River Endocrine Clinic - Endocrine	235 Hanover St	Fall River	MA	Active
DSH220074CX	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	Fall River Infectious Disease Clinic - Infectious Disease	235 Hanover St	Fall River	MA	Active
DSH220074CY	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	Southcoast Pulmonary Clinic - Pulmonology	208 MILL ROAD	FAIRHAVEN	MA	Active
DSH220074CZ	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	Southcoast Gastroenterology Clinic - Gastroenterology	208 MILL ROAD	FAIRHAVEN	MA	Active
DSH220074D	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	DBA ST. LUKE'S HOSPITAL	101 PAGE STREET	NEW BEDFORD	MA	Terminated
DSH220074DA	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST HEALTH MAKEPEACE WOUND C - Wound Care	43 HIGH ST	WAREHAM	MA	Active
DSH220074E	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	DBA TOBEY HOSPITAL	43 HIGH STREET	WAREHAM	MA	Terminated
DSH220074G	Child	DSH	SOUTHCOAST HOSPITALS GROUP INC	SOUTHCOAST SURGERY CENTER - ASC (NON-DISTINCT PART) - ASU Faunce Corner	300D FAUNCE CORNER RD	NORTH DARTMOUTH	MA	Terminated
DSH220074H	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST CENTER FOR CANCER CARE / ONCOLOGY CLINIC - Med Oncology	206 MILL RD	FAIRHAVEN	MA	Active
DSH220074J	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST CENTER FOR CANCER CARE / ONCOLOGY CLINIC - Radiation Oncology	206 MILL RD	FAIRHAVEN	MA	Active
DSH220074K	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	SOUTHCOAST CENTER FOR CANCER CARE / EKG	206 MILL RD	FAIRHAVEN	MA	Terminated
DSH220074L	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST CENTER FOR CANCER CARE / CT SCAN	206 MILL RD	FAIRHAVEN	MA	Active
DSH220074M	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST CENTER FOR CANCER CARE / PET SCAN	208 MILL RD	FAIRHAVEN	MA	Active
DSH220074N	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	SOUTHCOAST CENTER FOR CANCER CARE / Radiology - ULTRASOUND	206 MILL RD	FAIRHAVEN	MA	Terminated
DSH220074P	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST CENTER FOR CANCER CARE / Radiology - X-RAY	206 MILL RD	FAIRHAVEN	MA	Active
DSH220074Q	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	SOUTHCOAST CENTER FOR CANCER CARE / Radiology -MAMMOGRAPHY	206 MILL RD	FAIRHAVEN	MA	Terminated
DSH220074R	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	SOUTHCOAST SURGERY CENTER / ANESTHESIA	300D Faunce Corner Rd	North Dartmouth	MA	Terminated
DSH220074S	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST SURGERY CENTER / MAIN OR	300D Faunce Corner Rd	North Dartmouth	MA	Active
DSH220074T	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	SOUTHCOAST SURGERY CENTER / PERIOPERATIVE SERVICES	300D Faunce Corner Rd	North Dartmouth	MA	Active
DSH220074U	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC.	SOUTHCOAST SURGERY CENTER / PRE/POST OP	300D Faunce Corner Rd	North Dartmouth	MA	Terminated
DSH220074V	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - PERIOP SERVICES	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074W	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - PACU	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074X	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - GI SERVICES	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074Y	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - MAIN OR	101 PAGE ST	NEW BEDFORD	MA	Active
DSH220074Z	Child	DSH	SOUTHCOAST HOSPITALS GROUP, INC	ST. LUKE'S HOSPITAL / SLH - PRE/POST OP	101 PAGE ST	NEW BEDFORD	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/28/2024 9:17:42 AM	8/28/2024 9:17 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	110022082R (MA)		6/13/2024 10:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/13/2024 10:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110022082H	6/13/2024 10:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	6/13/2024 10:04 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1447275037 (MA)		6/13/2024 10:04 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1306871223	6/13/2024 10:04 PM
Medicaid Billing	NPI: State	Insert	Change Request		MA	6/13/2024 10:04 PM
Details	Entity Name	Update	Change Request	SOUTHCOAST HOSPITALS GROUP, INC.	SOUTHCOAST HOSPITALS GROUP, INC	5/20/2024 9:23 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Addresses	Main Address	Insert	New Registration		235 Hanover St Fall River, MA 02720	2/5/2024 11:06 AM
Contacts	Signed By	Insert	New Registration		Clark, Renee Exec. Vice President & Chief Operating Officer Southcoast Health 5089735872	2/5/2024 11:06 AM
Details	340B ID	Update	New Registration		DSH220074CW	2/5/2024 11:06 AM
Details	Entity Name	Update	New Registration	SOUTHCOAST HOSPITALS GROUP INC	SOUTHCOAST HOSPITALS GROUP, INC.	2/5/2024 11:06 AM
Details	Entity Subname	Update	New Registration	Fall River Endocrine Clinic	Fall River Endocrine Clinic - Endocrine	2/5/2024 11:06 AM
Dates	Participating Approval Date	Update	New Registration		2/5/2024 11:06:37 AM	2/5/2024 11:06 AM
Details	State	Update	New Registration	Pending	Approved	2/5/2024 11:06 AM
Dates	Signed By Date	Update	New Registration		2/1/2024 8:16:44 AM	2/5/2024 11:06 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	2/5/2024 11:06 AM
Addresses	Main Address	Insert	New Registration		235 Hanover St Fall River, MA 02720	2/1/2024 8:16 AM
Addresses	Main Address	Insert	New Registration		235 Hanover St Fall River, MA 02720	1/12/2024 12:54 AM
Details	Entity Subname	Update	New Registration	Charlton Memorial Hospital Endocrine Clinic	Fall River Endocrine Clinic	1/12/2024 12:54 AM
Addresses	Main Address	Insert	New Registration		235 Hanover St Fall River, MA 02720	1/11/2024 10:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 10:27 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1306871223	1/11/2024 10:27 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		RI	1/11/2024 10:27 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 10:27 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		110022082R	1/11/2024 10:27 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		MA	1/11/2024 10:27 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1306871223	1/11/2024 10:27 AM
Medicaid Billing	NPI: State	Insert	New Registration		RI	1/11/2024 10:27 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1447275037	1/11/2024 10:27 AM
Medicaid Billing	NPI: State	Insert	New Registration		MA	1/11/2024 10:27 AM
Contacts	Authorizing Official	Insert	New Registration		Clark, Renee Exec. Vice President & Chief Operating Officer Southcoast Health 5089735872	1/11/2024 10:27 AM
Contacts	Primary Contact	Insert	New Registration		Dean, Donald Pharmacy Director Southcoast Health 5089733022	1/11/2024 10:27 AM
Details	Assistance Received From Date	Insert	New Registration			1/11/2024 10:27 AM
Details	Assistance Received To Date	Insert	New Registration			1/11/2024 10:27 AM
Details	Last Recertification Date	Insert	New Registration			1/11/2024 10:27 AM
Details	Grant Number	Insert	New Registration			1/11/2024 10:27 AM
Details	340B ID	Insert	New Registration			1/11/2024 10:27 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2024 10:27 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2024 10:27 AM
Details	Medicare Provider Number	Insert	New Registration		220074	1/11/2024 10:27 AM
Details	Entity Name	Insert	New Registration		SOUTHCOAST HOSPITALS GROUP INC	1/11/2024 10:27 AM
Details	NOFO Number	Insert	New Registration			1/11/2024 10:27 AM
Details	Program Code	Insert	New Registration		DSH	1/11/2024 10:27 AM
Details	Entity Subname	Insert	New Registration		Charlton Memorial Hospital Endocrine Clinic	1/11/2024 10:27 AM
Dates	Participating Approval Date	Insert	New Registration			1/11/2024 10:27 AM
Details	State	Insert	New Registration		Pending	1/11/2024 10:27 AM
Dates	Registration Date	Insert	New Registration		1/11/2024 10:27:15 AM	1/11/2024 10:27 AM
Dates	Signed By Date	Insert	New Registration			1/11/2024 10:27 AM
Dates	Start Date	Insert	New Registration			1/11/2024 10:27 AM
Terminations	Termination Comments	Insert	New Registration			1/11/2024 10:27 AM
Terminations	Termination Date	Insert	New Registration			1/11/2024 10:27 AM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2024 10:27 AM
Terminations	Termination Reason	Insert	New Registration			1/11/2024 10:27 AM