Covered Entity Details

DSH220011Q CAMBRIDGE PUBLIC HEALTH COMMISSION (Active) - information as of 5/9/2025 10:43:48 PM

Main Details

Name

CAMBRIDGE PUBLIC HEALTH COMMISSION

Subdivision Name

CHA CAMBRIDGE BIRTH CENTER

Type

Disproportionate Share Hospital

Rural

340B ID

DSH220011Q

Medicare Provider Number

220011

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

11/17/2005

Participating Start Date

11/17/2005

Participating Approval Date

11/17/2005

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

Cambridge Public Health Commission
Andrew M Fuqua, Senior Vice President and General Counsel
(617) 665-1000

Primary Contact

Cambridge Public Health Commission
Maria Kossilos, Associate Chief Pharmacy Officer
(617) 806-8505

Addresses

Street Address

10 CAMELLIA AVENUE
CAMBRIDGE, MA 02139

Billing Address

Cambridge Public Health Commission
1493 Cambridge Street
CHA Outpatient Pharmacy
Cambridge, MA 02139

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
MA	110026529D	1487603585

Shipping Addresses

Shipping Address 1

Cambridge Public Health Commission
1493 CAMBRIDGE STREET
CAMBRIDGE, MA 02139

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
DSH220011A	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA CAMBRIDGE HOSPITAL	1493 CAMBRIDGE STREET	CAMBRIDGE	MA	Active
DSH220011AA	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA TEEN CONNECTION AT SOMERVILLE HIGH SCHOOL	81 HIGHLAND AVE	SOMERVILLE	MA	Active
DSH220011AB	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA ANNA MAY POWERS HEALTH CENTER	28 NICHOLS STREET	EVERETT	MA	Terminated
DSH220011AC	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Everett Care Center	391 Broadway	Everett	MA	Active
DSH220011AD	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	The Cambridge Hospital	1493 Cambridge Street	Cambridge	MA	Terminated
DSH220011AE	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Everett Teen Clinic at EHS	100 Elm Street	Everett	MA	Active
DSH220011AF	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Malden Care Center	195 Canal Street	Malden	MA	Active
DSH220011AG	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Malden Teen Health Center at MHS - Primary Care, Behavioral Health	77 Salem Street	Malden	MA	Active
DSH220011B	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA SOMERVILLE	33 Tower Street/ 230 Highland Avenue	SOMERVILLE	MA	Active
DSH220011C	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Everett Hospital	103 GARLAND STREET	EVERETT	MA	Active
DSH220011D	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA EAST CAMBRIDGE CARE CENTER	163 GORE ST	CAMBRIDGE	MA	Active
DSH220011F	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA WINDSOR STREET CARE CENTER	119 WINDSOR ST	CAMBRIDGE	MA	Active
DSH220011I	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA CAMBRIDGE FAMILY HEALTH	237 HAMPSHIRE ST	CAMBRIDGE	MA	Active
DSH220011K	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	UNION SQUARE HEALTH CENTER	337 SOMERVILLE AVENUE	SOMERVILLE	MA	Terminated
DSH220011L	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA CENTRAL STREET CARE CENTER	26 CENTRAL ST	SOMERVILLE	MA	Active
DSH220011M	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	ELDER SERVICE PLAN	163 Gore Street	CAMBRIDGE	MA	Active
DSH220011N	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA CAMBRIDGE PEDIATRICS	1493 CAMBRIDGE ST	CAMBRIDGE	MA	Active
DSH220011O	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Primary Care Cambridge Hospital	1493 CAMBRIDGE ST	CAMBRIDGE	MA	Active
DSH220011P	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA EYE CENTER	236 HIghland Avenue	Somerville	MA	Active
DSH220011Q	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA CAMBRIDGE BIRTH CENTER	10 CAMELLIA AVENUE	CAMBRIDGE	MA	Active
DSH220011R	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA ZINBERG CLINIC	1493 CAMBRIDGE ST	CAMBRIDGE	MA	Active
DSH220011S	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA WOMEN'S IMAGING CENTER	96 GARLAND ST	EVERETT	MA	Active
DSH220011T	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Revere Care Center	454 BROADWAY	REVERE	MA	Active
DSH220011U	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA CAMBRIDGE FAMILY HEALTH NORTH	2067 MASSACHUSETTS AVE	CAMBRIDGE	MA	Active
DSH220011V	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA BROADWAY CARE CENTER	300 BROADWAY	SOMERVILLE	MA	Active
DSH220011W	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Primary Care, Somerville Hospital	236 HIGHLAND AVE	SOMERVILLE	MA	Active
DSH220011Y	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA Assembly Square Care Center	5 MIDDLESEX AVE	SOMERVILLE	MA	Active
DSH220011Z	Child	DSH	CAMBRIDGE PUBLIC HEALTH COMMISSION	CHA TEEN HEALTH CENTER AT CRLS	459 BROADWAY	CAMBRIDGE	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 1:59:32 PM	8/30/2024 2:57:18 PM	8/30/2024 2:57 PM
Details	Last Recertification Date	Update	Recertification	9/14/2022 9:29:01 AM	8/23/2023 1:59:32 PM	8/23/2023 1:59 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 9:13:57 AM	9/14/2022 9:29:01 AM	9/14/2022 9:29 AM
Details	Last Recertification Date	Update	Recertification	8/18/2020 8:51:23 AM	8/18/2021 9:13:57 AM	8/18/2021 9:13 AM
Medicaid Billing	NPI: State	Update	Recertification		MA	8/18/2020 8:51 AM
Details	Last Recertification Date	Update	Recertification	8/30/2019 10:36:35 AM	8/18/2020 8:51:23 AM	8/18/2020 8:51 AM
Details	Last Recertification Date	Update	Recertification	8/21/2018 10:51:44 AM	8/30/2019 10:36:35 AM	8/30/2019 10:36 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 9:35:11 PM	8/21/2018 10:51:44 AM	8/21/2018 10:51 AM
Details	Last Recertification Date	Update	Recertification	8/11/2016 12:00:00 AM	11/15/2017 9:35:11 PM	11/15/2017 9:35 PM
Details	Entity Subname	Update	Recertification	THE BIRTH CENTER	CHA CAMBRIDGE BIRTH CENTER	11/15/2017 9:35 PM
Contacts	Authorizing Official	Insert	AO Change Request		Fuqua, Andrew M Senior Vice President and General Counsel Cambridge Public Health Commission 6176651000	10/13/2017 2:39 PM
Contacts	Primary Contact	Update		Kossilos, Maria Associate Chief Pharmacy Officer 6178068505	Kossilos, Maria Associate Chief Pharmacy Officer Cambridge Public Health Commission 6178068505	9/26/2017 11:38 AM
Contacts	Primary Contact	Insert			Kossilos, Maria Associate Chief Pharmacy Officer 6178068505	5/22/2017 10:35 AM
Medicaid Billing	Medicaid: Number	Update		1211951	110026529D	8/11/2016 12:02 PM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/11/2016 12:00:00 AM	8/11/2016 12:02 PM
Addresses	Main Address	Update		10 CAMELLIA ST CAMBRIDGE, MA 02139	10 CAMELLIA AVENUE CAMBRIDGE, MA 02139	8/11/2016 12:02 PM
Addresses	Main Address	Insert			10 CAMELLIA ST CAMBRIDGE, MA 02139	8/11/2016 12:02 PM
Addresses	Billing Address	Update		CHA Outpatient Pharmacy 1493 Cambridge Street Cambridge, MA 02139	Cambridge Public Health Commission 1493 Cambridge Street CHA Outpatient Pharmacy Cambridge, MA 02139	10/21/2015 12:22 PM
Addresses	Shipping Address	Update		CHA OUTPATIENT PHARMACY 1493 CAMBRIDGE STREET CAMBRIDGE, MA 02139	Cambridge Public Health Commission 1493 CAMBRIDGE STREET CAMBRIDGE, MA 02139	10/21/2015 12:22 PM
Medicaid Billing	NPI: Number	Insert			1487603585	10/21/2015 12:22 PM
Addresses	Billing Address	Insert			CHA Outpatient Pharmacy 1493 Cambridge Street Cambridge, MA 02139	10/21/2015 12:21 PM
Addresses	Shipping Address	Insert			CHA OUTPATIENT PHARMACY 1493 CAMBRIDGE STREET CAMBRIDGE, MA 02139	10/21/2015 12:21 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/28/2015 8:52 AM
Details	Last Recertification Date	Update		8/21/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/28/2015 8:52 AM
Details	Last Recertification Date	Update		9/11/2013 12:00:00 AM	8/21/2014 12:00:00 AM	8/21/2014 1:08 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/11/2013 12:00:00 AM	9/11/2013 10:58 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	11/17/2005 7:32 AM
Medicaid Billing	Medicaid: Number	Insert			1211951	11/17/2005 7:32 AM
Medicaid Billing	Medicaid: State	Insert			MA	11/17/2005 7:32 AM
Details	Last Recertification Date	Insert				11/17/2005 7:32 AM
Details	Grant Number	Insert				11/17/2005 7:32 AM
Details	340B ID	Insert			DSH220011Q	11/17/2005 7:32 AM
Details	Is Authorizing Official EHB Data	Insert				11/17/2005 7:32 AM
Dates	Last Date That 340B Drugs Purchased	Insert				11/17/2005 7:32 AM
Details	Medicare Provider Number	Insert			220011	11/17/2005 7:32 AM
Details	Entity Name	Insert			CAMBRIDGE PUBLIC HEALTH COMMISSION	11/17/2005 7:32 AM
Details	Program Code	Insert			DSH	11/17/2005 7:32 AM
Details	Entity Subname	Insert			THE BIRTH CENTER	11/17/2005 7:32 AM
Dates	Participating Approval Date	Insert			11/17/2005 12:00:00 AM	11/17/2005 7:32 AM
Details	State	Insert			Active	11/17/2005 7:32 AM
Dates	Registration Date	Insert			11/17/2005 12:00:00 AM	11/17/2005 7:32 AM
Dates	Signed By Date	Insert			10/21/2005 12:00:00 AM	11/17/2005 7:32 AM
Dates	Start Date	Insert			11/17/2005 12:00:00 AM	11/17/2005 7:32 AM
Terminations	Termination Comments	Insert				11/17/2005 7:32 AM
Terminations	Termination Date	Insert				11/17/2005 7:32 AM
Terminations	Termination Effective Date	Insert				11/17/2005 7:32 AM
Terminations	Termination Reason	Insert				11/17/2005 7:32 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

Parent/Child

History