Covered Entity Details

DSH220019 UMass Memorial Health - Harrington Hospital, Inc. (Active) - information as of 4/25/2025 5:40:39 PM

Main Details

Name

UMass Memorial Health - Harrington Hospital, Inc.

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH220019

Medicare Provider Number

220019

Additional Details

Current Program Status

Active

Registration Date

5/29/2009

Participating Start Date

7/1/2009

Participating Approval Date

6/3/2009

Last Recertification Date

9/9/2024

Contacts

Authorizing Official

UMass Memorial Health-Harrington
Edward Moore, President
(508) 765-3002

Primary Contact

UMass Memorial Health-Harrington
Kristie Reed, Pharmacy Director
(508) 765-3105

Addresses

Street Address

100 SOUTH STREET
SOUTHBRIDGE, MA 01550

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
MA		1790780047
CT		1790780047
NY		1790780047
NC		1790780047
RI		1790780047

Shipping Addresses

Shipping Address 1

UMass Memorial Health Harrington Hospital-Safecor Health LLC
317 New Boston St
Suite 100
Woburn, MA 01801

Shipping Address 2

UMass Memorial Health-Harrington
100 South St
Southbridge, MA 01550

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00765	399 MAIN STREET	SOUTHBRIDGE	MA	01550	11/29/2012	11/29/2012		02/19/2016
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00038	142 WORCESTER RD.	CHARLTON	MA	01507	11/29/2012	11/29/2012		02/19/2016
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00498	112 E. MAIN ST.	WEBSTER	MA	01570	11/29/2012	11/29/2012		02/19/2016
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 00582	95 MAIN ST	SPENCER	MA	01562	10/15/2019	01/01/2020		01/01/2020
Contract Detail	CVS PHARMACY, INC.	CVS/PHARMACY # 10649	362 MAIN STREET	STURBRIDGE	MA	01566	10/12/2021	01/01/2022		01/01/2022
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 01111	104 WEST ST.	WARE	MA	01082	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CVS PHARMACY, INC.	DBA: CVS/PHARMACY # 02161	302 MAIN STREET	OXFORD	MA	01540	07/20/2023	10/01/2023		10/01/2023
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/20/2023	10/01/2023		10/01/2023
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	10/17/2016	01/01/2017	12/03/2018	12/03/2018
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	G3320 BEECHER RD		FLINT	MI	48532-3614	10/17/2016	01/01/2017	12/03/2018	12/03/2018
Contract Detail	MAXI DRUG, INC.	RITE AID #10090	455 MAIN STREET	SOUTHBRIDGE	MA	01550	02/20/2013	04/01/2013	03/15/2018	03/15/2018
Contract Detail	MAXI DRUG, INC.	RITE AID #10093	5 SCHOFIELD AVENUE	DUDLEY	MA	01571	02/20/2013	04/01/2013	03/15/2018	03/15/2018
Contract Detail	MAXI DRUG, INC.	RITE AID #10091	182 MAIN ST.	STURBRIDGE	MA	01566	07/11/2016	10/01/2016	03/15/2018	03/15/2018
Contract Detail	MAXI DRUG, INC.	RITE AID #10092	80 EAST MAIN STREET	WEBSTER	MA	01570	07/20/2023	10/01/2023	10/01/2023	11/02/2023
Contract Detail	ONCOMED PHARMACEUTICAL SERVICES OF MA, L	D/B/A ONCO360	335 BEAR HILL RD STE 2100	WALTHAM	MA	02451	04/07/2017	07/01/2017		04/07/2017
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	734 FOREST ST. SUITE 300	MARLBOROUGH	MA	01752-3032	04/11/2016	07/01/2016	12/03/2018	12/03/2018
Contract Detail	OPTION CARE ENTERPRISES, INC.	D/B/A OPTION CARE	11403 BLUEGRASS PARKWAY SUITE 400	LOUISVILLE	KY	40299-2398	04/15/2016	07/01/2016	12/03/2018	12/03/2018
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/20/2023	10/01/2023		10/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/20/2023	10/01/2023		10/01/2023
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/20/2023	10/01/2023		10/01/2023
Contract Detail	RMG PHARMACY INC	11-15 SANDERSDALE ROAD		SOUTHBRIDGE	MA	01550	07/20/2023	10/01/2023		10/01/2023
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	04/14/2022	07/01/2022		07/01/2022
Contract Detail	UMASS MEMORIAL MEDICAL CENTER	55 LAKE AVE N	ATTN: DEPARTMENT OF PHARMACY	WORCESTER	MA	01655	07/12/2018	10/01/2018	09/30/2022	10/03/2022
Contract Detail	UMASS MEMORIAL MEDICAL CENTER, INC.	UMASS MEMORIAL MEDICAL CENTER SPECIALTY	55 LAKE AVE N ACC BUILDING - 1ST FLOOR - SUITE AC1.033	WORCESTER	MA	01655-0002	04/12/2018	07/01/2018	09/30/2022	10/03/2022
Contract Detail	UMASS MEMORIAL MEDICAL CENTER, INC.	UMASS MEMORIAL MEDICAL CENTER SPECIALTY	55 LAKE AVE N ACC BUILDING - 1ST FLOOR - SUITE AC1.033	WORCESTER	MA	01655-0002	10/17/2022	01/01/2023		01/01/2023
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/20/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2797	100 CHARLTON ROAD		STURBRIDGE	MA	01566	04/05/2019	07/01/2019		07/01/2019
Contract Detail	WAL-MART PHARMACY 10-3409	20 SOOJIANS DR		LEICESTER	MA	01524	07/20/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/20/2023	10/01/2023		10/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01233	100 E MAIN ST	WEBSTER	MA	01570	04/07/2017	07/01/2017		04/07/2017
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19506	178 MAIN ST	STURBRIDGE	MA	01566	03/15/2018	03/15/2018	01/18/2023	03/15/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #18421	455 MAIN ST	SOUTHBRIDGE	MA	01550	03/15/2018	03/15/2018		04/04/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19240	5 SCHOFIELD AVE	DUDLEY	MA	01571	03/15/2018	03/15/2018		04/04/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19747	175 MAIN ST	OXFORD	MA	01540	10/15/2018	01/01/2019	03/02/2023	07/20/2023
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS SPECIALTY PHARMACY 16486	398 BELMONT ST SUITE A	WORCESTER	MA	01604	07/20/2023	10/01/2023		10/01/2023
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	04/12/2023	07/01/2023		07/01/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/20/2023	10/01/2023		10/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/18/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH220019A	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	UMass Memorial Health - Harrington at Webster-Emergency Room	340 THOMPSON RD	WEBSTER	MA	Active
DSH220019B	Child	DSH	HARRINGTON MEMORIAL HOSPITAL	HARRINGTON HEALTHCARE AT HUBBARD / Operating Room	340 THOMPSON RD	WEBSTER	MA	Terminated
DSH220019C	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	The Cancer Center at Harrington-Infusion Clinic	55 Sayles Street	Southbridge	MA	Active
DSH220019D	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	UMass Memorial Health - Harrington Wound Care Center	10 North Main Street	Charlton	MA	Active
DSH220019E	Child	DSH	HARRINGTON MEMORIAL HOSPITAL	HARRINGTON HEALTHCARE AT HUBBARD / Surigical Day Care	340 THOMPSON RD	WEBSTER	MA	Terminated
DSH220019F	Child	DSH	HARRINGTON MEMORIAL HOSPITAL	HARRINGTON HEALTHCARE AT HUBBARD / Anesthesia	340 THOMPSON RD	WEBSTER	MA	Terminated
DSH220019G	Child	DSH	HARRINGTON MEMORIAL HOSPITAL	HARRINGTON HEALTHCARE AT HUBBARD / Recovery Room	340 THOMPSON RD	WEBSTER	MA	Terminated
DSH220019H	Child	DSH	HARRINGTON MEMORIAL HOSPITAL	Harrington Hospital Outpatient Behavioral Health	161 West Main Stree	Dudley	MA	Terminated
DSH220019J	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	UMass Memorial Health - Harrington Behavioral Health Recovery Services	176 Main Street	Southbridge	MA	Terminated
DSH220019K	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	UMass Memorial Health - Harrington Mental Health	29 Pine Street	Southbridge	MA	Active
DSH220019L	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	HARRINGTON MEMORIAL HOSPITAL, INC. - UMass Memorial Health-Addiction Immediate Care	340 THOMPSON RD	WEBSTER	MA	Active
DSH220019M	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	HARRINGTON MEMORIAL HOSPITAL OBH - UMass Memorial Health-Child and Family Mental health	139 SOUTH ST	SOUTHBRIDGE	MA	Active
DSH220019N	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	The Cancer Center at Harrington - Oncology Clinic	55 Sayles St	Southbridge	MA	Active
DSH220019P	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	Harrington Substance Abuse at Pine St - Substance Abuse	29 Pine St	Southbridge	MA	Active
DSH220019Q	Child	DSH	UMass Memorial Health - Harrington Hospital, Inc.	Harrington Healthcare at Webster - Substance Abuse	340 Thompson Rd	Webster	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Recertification	UMass Memorial Health-Harrington 100 South Sto Southbridge, MA 01550		9/9/2024 10:36 AM
Addresses	Shipping Address	Insert	Recertification		UMass Memorial Health-Harrington 100 South St Southbridge, MA 01550	9/9/2024 10:36 AM
Details	Last Recertification Date	Update	Recertification	8/21/2023 2:26:02 PM	9/9/2024 10:36:01 AM	9/9/2024 10:36 AM
Addresses	Shipping Address	Insert	Change Request		UMass Memorial Health-Harrington 100 South Sto Southbridge, MA 01550	6/6/2024 8:15 AM
Addresses	Shipping Address	Insert	Change Request		UMass Memorial Health Harrington Hospital-Safecor Health LLC 317 New Boston St Suite 100 Woburn, MA 01801	6/6/2024 8:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (ME)		6/6/2024 8:15 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003023603 (CT)		3/28/2024 11:18 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	110024448B (MA)		3/28/2024 11:18 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	3/28/2024 11:18 AM
Medicaid Billing	NPI: State	Insert	Change Request		ME	3/28/2024 11:18 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	3/28/2024 11:18 AM
Medicaid Billing	NPI: State	Insert	Change Request		NY	3/28/2024 11:18 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	3/28/2024 11:18 AM
Medicaid Billing	NPI: State	Insert	Change Request		NC	3/28/2024 11:18 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	3/28/2024 11:18 AM
Medicaid Billing	NPI: State	Insert	Change Request		RI	3/28/2024 11:18 AM
Details	Last Recertification Date	Update	Recertification	9/16/2022 12:37:08 PM	8/21/2023 2:26:02 PM	8/21/2023 2:26 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	110024448C (MA)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0014031340001 (PA)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0220019 (VT)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	090923800 (FL)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	14500000 (ME)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	3080278 (NH)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	880832 (AZ)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	ha08158 (RI)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	7037309 (NJ)		3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/15/2023 4:46 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		110024448B	3/15/2023 4:46 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MA	3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (PA)		3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (VT)		3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (FL)		3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (ME)		3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (NH)		3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (AZ)		3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (RI)		3/15/2023 4:46 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1790780047 (NJ)		3/15/2023 4:46 PM
Contacts	Primary Contact	Update	Profile Change Request	Reed, Kristie Pharmacy Operations Manager Harrington Memorial Hospital 5087653105	Reed, Kristie Pharmacy Director UMass Memorial Health-Harrington 5087653105	3/14/2023 1:38 PM
Details	Last Recertification Date	Update	Recertification	8/30/2021 1:09:03 PM	9/16/2022 12:37:08 PM	9/16/2022 12:37 PM
Contacts	Authorizing Official	Update	AO Change Request	SULLIVAN, THOMAS J. Vice President & CFO Harrington Hospital 5087658130	Moore, Edward President UMass Memorial Health-Harrington 5087653002	9/15/2022 12:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0014031340001	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003023603	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0220019	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		VT	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		090923800	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		14500000	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		ME	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		3080278	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NH	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		880832	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		ha08158	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		RI	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		7037309	1/21/2022 10:03 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		CT	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		VT	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		FL	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		ME	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		NH	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		AZ	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		RI	1/21/2022 10:03 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1790780047	1/21/2022 10:03 AM
Medicaid Billing	NPI: State	Insert	Change Request		NJ	1/21/2022 10:03 AM
Details	Entity Name	Update	Change Request	HARRINGTON MEMORIAL HOSPITAL	UMass Memorial Health - Harrington Hospital, Inc.	1/21/2022 10:03 AM
Details	Last Recertification Date	Update	Recertification	8/31/2020 10:49:21 AM	8/30/2021 1:09:03 PM	8/30/2021 1:09 PM
Contacts	Primary Contact	Update	Group Change Request	Dubois, Anthony Pharmacy Director Harrington memorial Hospital 5087653110	Reed, Kristie Pharmacy Operations Manager Harrington Memorial Hospital 5087653105	7/28/2021 9:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2020 10:49 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		110024448C	8/31/2020 10:49 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		MA	8/31/2020 10:49 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1200704 (MA)		8/31/2020 10:49 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1790780047	8/31/2020 10:49 AM
Medicaid Billing	NPI: State	Insert	Recertification		MA	8/31/2020 10:49 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1790780047 ( )		8/31/2020 10:49 AM
Details	Last Recertification Date	Update	Recertification	8/28/2019 9:44:21 AM	8/31/2020 10:49:21 AM	8/31/2020 10:49 AM
Details	Last Recertification Date	Update	Recertification	8/27/2018 1:25:28 PM	8/28/2019 9:44:21 AM	8/28/2019 9:44 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 3:41:22 PM	8/27/2018 1:25:28 PM	8/27/2018 1:25 PM
Details	Last Recertification Date	Update	Recertification	8/17/2016 12:00:00 AM	11/29/2017 3:41:22 PM	11/29/2017 3:41 PM
Contacts	Primary Contact	Update		Dubois, Anthony Pharmacy Director 5087653110	Dubois, Anthony Pharmacy Director Harrington memorial Hospital 5087653110	10/20/2017 9:47 AM
Contacts	Authorizing Official	Update		SULLIVAN, THOMAS J. Vice President & CFO 5087658130	SULLIVAN, THOMAS J. Vice President & CFO Harrington Hospital 5087658130	10/10/2017 9:31 AM
Contacts	Primary Contact	Update		JEZERSKI, JAMES DIRECTOR OF PHARMACY 5087653110	Dubois, Anthony Pharmacy Director 5087653110	5/17/2017 12:28 PM
Contacts	Authorizing Official	Insert			SULLIVAN, THOMAS J. Vice President & CFO 5087658130	4/7/2017 3:30 PM
Addresses	Main Address	Insert			100 SOUTH STREET SOUTHBRIDGE, MA 01550	8/17/2016 1:46 PM
Details	Last Recertification Date	Update		8/27/2015 12:00:00 AM	8/17/2016 12:00:00 AM	8/17/2016 1:46 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/27/2015 9:43 AM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/27/2015 12:00:00 AM	8/27/2015 9:43 AM
Medicaid Billing	NPI: Number	Insert			1790780047	9/3/2014 1:20 PM
Details	Last Recertification Date	Update		8/22/2013 12:00:00 AM	9/3/2014 12:00:00 AM	9/3/2014 1:20 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/22/2013 12:00:00 AM	8/22/2013 6:06 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/15/2012 7:50 AM
Contacts	Primary Contact	Insert			JEZERSKI, JAMES DIRECTOR OF PHARMACY 5087653110	6/3/2009 1:09 PM
Details	Last Recertification Date	Insert				6/3/2009 1:09 PM
Details	Grant Number	Insert				6/3/2009 1:09 PM
Details	340B ID	Insert			DSH220019	6/3/2009 1:09 PM
Details	Is Authorizing Official EHB Data	Insert				6/3/2009 1:09 PM
Dates	Last Date That 340B Drugs Purchased	Insert				6/3/2009 1:09 PM
Details	Medicare Provider Number	Insert			220019	6/3/2009 1:09 PM
Details	Entity Name	Insert			HARRINGTON MEMORIAL HOSPITAL	6/3/2009 1:09 PM
Details	Program Code	Insert			DSH	6/3/2009 1:09 PM
Details	Entity Subname	Insert				6/3/2009 1:09 PM
Dates	Participating Approval Date	Insert			6/3/2009 12:00:00 AM	6/3/2009 1:09 PM
Details	State	Insert			Active	6/3/2009 1:09 PM
Dates	Registration Date	Insert			5/29/2009 12:00:00 AM	6/3/2009 1:09 PM
Dates	Signed By Date	Insert			2/12/2009 12:00:00 AM	6/3/2009 1:09 PM
Dates	Start Date	Insert			7/1/2009 12:00:00 AM	6/3/2009 1:09 PM
Terminations	Termination Comments	Insert				6/3/2009 1:09 PM
Terminations	Termination Date	Insert				6/3/2009 1:09 PM
Terminations	Termination Effective Date	Insert				6/3/2009 1:09 PM
Terminations	Termination Reason	Insert				6/3/2009 1:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	5/29/2009 2:59 PM
Medicaid Billing	Medicaid: Number	Insert			1200704	5/29/2009 2:59 PM
Medicaid Billing	Medicaid: State	Insert			MA	5/29/2009 2:59 PM