Covered Entity Details

DSH220063A THE LOWELL GENERAL HOSPITAL (Terminated) - information as of 5/20/2025 11:33:41 PM

Main Details

Name

THE LOWELL GENERAL HOSPITAL

Subdivision Name

THE SURGERY CENTER AT DRUM HILL

Type

Disproportionate Share Hospital

Rural

340B ID

DSH220063A

Medicare Provider Number

220063

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/23/2007

Participating Start Date

7/1/2004

Participating Approval Date

10/23/2007

Last Recertification Date

8/26/2020

Termination Date
Termination Reason

10/1/2021
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

TuftsMedicine
William F Wyman, SVP of Operations & Treasurer
(978) 937-6034

Primary Contact

Lowell General
Eric Musial, Director of Pharmacy Services
(978) 937-6416

Addresses

Street Address

10 RESEARCH PLACE
NORTH CHELMSFORD, MA 01863

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
CT	003023918	1407804669
NY	01546941	1407804669
VT	0220063	1407804669
CA	1407804669	1407804669
ME	1407804669	1407804669
NC	1407804669	1407804669
NH	3071539	1407804669
FL	901289300	1407804669
MA	110026472	1407804669

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
DSH220063A	Child	DSH	THE LOWELL GENERAL HOSPITAL	THE SURGERY CENTER AT DRUM HILL	10 RESEARCH PLACE	NORTH CHELMSFORD	MA	Terminated
DSH220063B	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Radiology	1 Hosptial Drive	Lowell	MA	Active
DSH220063C	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Interventional Radiology	1 Hospital Drive	Lowell	MA	Active
DSH220063D	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / TB/Immunization Clinic	1 Hospital Drive	Lowell	MA	Active
DSH220063E	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Adults & Peds Observation	1 Hospital Drive	Lowell	MA	Active
DSH220063F	Child	DSH	THE LOWELL GENERAL HOSPITAL	THE LOWELL GENERAL HOSPITAL	1230 BRIDGE ST	LOWELL	MA	Terminated
DSH220063G	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / ALS	1 Hospital Drive	Lowell	MA	Active
DSH220063H	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Surgical Day Care	1 Hospital Drive	Lowell	MA	Active
DSH220063J	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Endoscopy	1 Hospital Drive	Lowell	MA	Active
DSH220063K	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Medical Day Care Clinic	1 Hospital Drive	Lowell	MA	Active
DSH220063L	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Anesthesia	1 Hospital Drive	Lowell	MA	Active
DSH220063M	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / PACU	1 Hospital Drive	Lowell	MA	Active
DSH220063N	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Operating Rooms	1 Hospital Drive	Lowell	MA	Terminated
DSH220063P	Child	DSH	THE LOWELL GENERAL HOSPITAL	Saints Campus / Emergency Department	1 Hospital Drive	Lowell	MA	Active
DSH220063Q	Child	DSH	THE LOWELL GENERAL HOSPITAL	THE LOWELL GENERAL HOSPITAL / Pain Clinic	2 HOSPITAL DR 2	LOWELL	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Profile Change Request	Wyman, William F SVP of Finance & Treasurer Lowell General Hospial 9789376034	Wyman, William F SVP of Operations & Treasurer TuftsMedicine 9789376034	7/13/2022 6:31 AM
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		9/10/2021 12:00:00 AM	8/19/2021 1:50 PM
Details	State	Update	Recertification	Active	To Be Terminated	8/19/2021 1:50 PM
Terminations	Termination Comments	Update	Recertification		Ownership and operation being transferred	8/19/2021 1:50 PM
Terminations	Termination Date	Update	Recertification		10/1/2021 12:00:00 AM	8/19/2021 1:50 PM
Terminations	Termination Effective Date	Update	Recertification		10/1/2021 12:00:00 AM	8/19/2021 1:50 PM
Terminations	Termination Reason	Update	Recertification		Hospital Outpatient facility no longer eligible	8/19/2021 1:50 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		003023918	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CT	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		01546941	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NY	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		0220063	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		VT	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		ME	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NC	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		3071539	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		NH	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		901289300	8/26/2020 9:57 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		FL	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		CT	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		VT	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		CA	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		ME	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		NH	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1407804669	8/26/2020 9:57 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/26/2020 9:57 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1407804669 ( )		8/26/2020 9:57 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 8:57:07 PM	8/26/2020 9:57:21 AM	8/26/2020 9:57 AM
Details	Last Recertification Date	Update	Recertification	8/17/2018 7:37:59 AM	8/20/2019 8:57:07 PM	8/20/2019 8:57 PM
Contacts	Authorizing Official	Update	Profile Change Request	Wyman, William Vice President of Finance Lowell General Hospial 9789376034	Wyman, William F SVP of Finance & Treasurer Lowell General Hospial 9789376034	8/20/2019 8:49 PM
Details	Last Recertification Date	Update	Recertification	11/10/2017 12:35:51 PM	8/17/2018 7:37:59 AM	8/17/2018 7:37 AM
Contacts	Authorizing Official	Update	Change Request	Green, Susan Chief Financial Officer Lowell General Hospital 9787887143	Wyman, William Vice President of Finance Lowell General Hospial 9789376034	1/17/2018 7:37 AM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/10/2017 12:35:51 PM	11/10/2017 12:35 PM
Contacts	Authorizing Official	Insert	AO Change Request		Green, Susan Chief Financial Officer Lowell General Hospital 9787887143	11/7/2017 10:31 AM
Contacts	Primary Contact	Update		Musial, Eric Director of Pharmacy Services 9789376416	Musial, Eric Director of Pharmacy Services Lowell General 9789376416	11/6/2017 2:02 PM
Contacts	Primary Contact	Update		Branco, Wallace DIRECTOR PHARMACY SERVICES 9789376175	Musial, Eric Director of Pharmacy Services 9789376416	9/14/2016 6:58 AM
Addresses	Main Address	Insert			10 RESEARCH PLACE NORTH CHELMSFORD, MA 01863	9/14/2016 6:58 AM
Details	Last Recertification Date	Update		8/31/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 9:17 AM
Contacts	Primary Contact	Update		RITCHIE, ROBERT DIRECTOR OF PHARMACY SERVICES 9789376175	Branco, Wallace DIRECTOR PHARMACY SERVICES 9789376175	8/31/2015 1:42 PM
Details	Last Recertification Date	Update		9/5/2014 12:00:00 AM	8/31/2015 12:00:00 AM	8/31/2015 1:42 PM
Details	Entity Name	Update		LOWELL GENERAL HOSPITAL	THE LOWELL GENERAL HOSPITAL	7/30/2015 9:47 AM
Dates	Participating Approval Date	Update		10/23/2007 1:26:13 PM	10/23/2007 12:00:00 AM	7/30/2015 9:47 AM
Details	Last Recertification Date	Update		9/10/2013 2:03:05 PM	9/5/2014 12:00:00 AM	9/5/2014 11:51 AM
Contacts	Primary Contact	Insert			RITCHIE, ROBERT DIRECTOR OF PHARMACY SERVICES 9789376175	7/3/2014 4:20 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/10/2013 2:03:05 PM	9/10/2013 2:03 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	5/29/2012 12:35 PM
Medicaid Billing	Medicaid: Number	Update		1201069	110026472	5/29/2012 12:35 PM
Medicaid Billing	NPI: Number	Insert			1407804669	5/29/2012 12:35 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/29/2012 12:35 PM
Details	Last Recertification Date	Insert				10/23/2007 1:29 PM
Details	Grant Number	Insert				10/23/2007 1:29 PM
Details	340B ID	Insert			DSH220063A	10/23/2007 1:29 PM
Details	Is Authorizing Official EHB Data	Insert				10/23/2007 1:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/23/2007 1:29 PM
Details	Medicare Provider Number	Insert			220063	10/23/2007 1:29 PM
Details	Entity Name	Insert			LOWELL GENERAL HOSPITAL	10/23/2007 1:29 PM
Details	Program Code	Insert			DSH	10/23/2007 1:29 PM
Details	Entity Subname	Insert			THE SURGERY CENTER AT DRUM HILL	10/23/2007 1:29 PM
Dates	Participating Approval Date	Insert			10/23/2007 1:26:13 PM	10/23/2007 1:29 PM
Details	State	Insert			Active	10/23/2007 1:29 PM
Dates	Registration Date	Insert			10/23/2007 12:00:00 AM	10/23/2007 1:29 PM
Dates	Signed By Date	Insert				10/23/2007 1:29 PM
Dates	Start Date	Insert			7/1/2004 12:00:00 AM	10/23/2007 1:29 PM
Terminations	Termination Comments	Insert				10/23/2007 1:29 PM
Terminations	Termination Date	Insert				10/23/2007 1:29 PM
Terminations	Termination Effective Date	Insert				10/23/2007 1:29 PM
Terminations	Termination Reason	Insert				10/23/2007 1:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	10/23/2007 1:28 PM
Medicaid Billing	Medicaid: Number	Insert			1201069	10/23/2007 1:28 PM
Medicaid Billing	Medicaid: State	Insert			MA	10/23/2007 1:28 PM