Covered Entity Details

DSH220071BJ MASSACHUSETTS GENERAL HOSPITAL (Active) - information as of 5/3/2025 11:30:30 PM

Main Details

Name

MASSACHUSETTS GENERAL HOSPITAL

Subdivision Name

THE GENERAL HOSPITAL CORPORATION / Electroencephalography EEG

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH220071BJ

Medicare Provider Number

220071

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

3/16/2021

Participating Start Date

3/24/2021

Participating Approval Date

3/24/2021

Last Recertification Date

9/5/2024

Contacts

Authorizing Official

Mass General Hospital
Sally Mason Boemer, Senior Vice President of Finance
(617) 724-4537

Primary Contact

Massachusetts General Hospital
Rafic Nehme, Director, Pharmacy Business & Finance
(617) 726-5125

Addresses

Street Address

165 CAMBRIDGE STREET
MGH CHARLES RIVER PLAZA
BOSTON, MA 02114-2783

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 10/1/2017, terminated 1/1/2020. Reinstated 4/1/2021.	03/23/2021

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	110001958	1023049236

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
DSH220071A	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Rheumatology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AA	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pediatric Endocrinology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AB	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pediatric Specialties I	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AC	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pediatric Group Practices	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AD	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pediatric Nephrology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AE	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pediatric Cardiology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AF	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pedi Hem/Onc Evaluation	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AG	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Medical Oncology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071AH	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Everett - Internal Med	100 EVERETT AVENUE	CHELSEA	MA	Active
DSH220071AJ	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Danvers ACC - Transplant	102 ENDICOTT STREET	DANVERS	MA	Active
DSH220071AK	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH West - Ambulatory Surgery	52 Second Avenue	WALTHAM	MA	Active
DSH220071AL	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / ACC - Surgery	102 ENDICOTT STREET	DANVERS	MA	Active
DSH220071AM	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Revere - Internal Medicine	385 BROADWAY	REVERE	MA	Active
DSH220071AN	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH HEALTH CENTER REVERE / MGH Revere - Specialties	300 OCEAN AVE	REVERE	MA	Active
DSH220071AP	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH HEALTH CENTER REVERE / MGH Revere -Med Peds	300 OCEAN AVE	REVERE	MA	Active
DSH220071AQ	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH HEALTH CENTER REVERE / MGH Revere - Dermatology	300 OCEAN AVE	REVERE	MA	Active
DSH220071AR	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH HEALTH CENTER REVERE / MGH Revere - Pediatrics	300 OCEAN AVE	REVERE	MA	Active
DSH220071AS	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH HEALTH CENTER REVERE / MGH Revere - Health Associate	300 OCEAN AVE	REVERE	MA	Active
DSH220071AT	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH Back Bay Primary Health Clinic	388 COMMONWEALTH AVENUE	BOSTON	MA	Active
DSH220071AU	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Chelsea - Urgent Care	151 EVERETT AVENUE	CHELSEA	MA	Active
DSH220071AV	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Charlestown - Podiatry	73 HIGH ST	CHARLESTOWN	MA	Active
DSH220071AW	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Charlestown - Pediatric Med	73 HIGH ST	CHARLESTOWN	MA	Active
DSH220071AX	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Charlestown -Mental Health	73 HIGH ST	CHARLESTOWN	MA	Active
DSH220071AY	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Charlestown - Internal Med	73 HIGH ST	CHARLESTOWN	MA	Active
DSH220071AZ	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Charlestown - Gynecology	73 HIGH ST	CHARLESTOWN	MA	Active
DSH220071B	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH CHARLES RIVER PLAZA / Transplant	165 CAMBRIDGE ST	BOSTON	MA	Active
DSH220071BA	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Charlestown - Dermatology	73 HIGH ST	CHARLESTOWN	MA	Active
DSH220071BB	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Everett Family Care-Intermal Med	19-23 NORWOOD STREET	EVERETT	MA	Terminated
DSH220071BC	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Everett Family Care - Everett Satelite	19-23 NORWOOD STREET	EVERETT	MA	Active
DSH220071BD	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION-STUDENT HEALTH CENTER	299 EVERETT AVENUE	CHELSEA	MA	Active
DSH220071BE	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH CHELSEA HEALTHCARE CENTER / MGH Chelsea- Pediatric Med	151 EVERETT AVE	CHELSEA	MA	Active
DSH220071BF	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH CHELSEA HEALTHCARE CENTER / MGH Chelsea - Med Specialties	151 EVERETT AVE	CHELSEA	MA	Active
DSH220071BG	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH CHELSEA HEALTHCARE CENTER / MGH Chelsea - INT	151 EVERETT AVE	CHELSEA	MA	Active
DSH220071BH	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH CHELSEA HEALTHCARE CENTER / MGH Chelsea - Gynecology	151 EVERETT AVE	CHELSEA	MA	Active
DSH220071BJ	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Electroencephalography EEG	165 CAMBRIDGE STREET	BOSTON	MA	Active
DSH220071BK	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/Revere Mental Health - MGH Revere Mental Health	300 Ocean Avenue	Revere	MA	Active
DSH220071BL	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/Back Bay Specialties - MGH Back Bay - Specialties	388 Commonwealth Avenue	Boston	MA	Active
DSH220071BM	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/Medical Oncology Group - MGH MEDICAL ONCOLOGY GROUP	52 Second Avenue	Waltham	MA	Active
DSH220071BN	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/Gynecology Clinic - Gynecology Clinic	32 Fruit Street	Boston	MA	Active
DSH220071BP	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/MGH CHILD PSYCHIATRY - MGH CHILD PSYCHIATRY	32 Fruit Street	Boston	MA	Active
DSH220071BQ	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/Chelsea Mental Health - MGH Chelsea Mental Health	151 Everett Avenue	Chelsea	MA	Active
DSH220071BR	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/MGH Chelsea Dermatology - MGH Chelsea Dermatology	151 Everett Avenue	Chelsea	MA	Active
DSH220071BS	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/Urology Clinic - Urology Clinic	165 Cambridge Street	Boston	MA	Active
DSH220071BT	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/Pain Danvers ACC - MGH Pain Danvers ACC	102 Endicott Street	Danvers	MA	Active
DSH220071BU	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MASS GENERAL WALTHAM - MG West Rheum	52 Second Avenue	Waltham	MA	Active
DSH220071BV	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/RHEUMATOLOGY ASSOCIATES - RHEUMATOLOGY ASSOCIATES	73 High Street	Charlestown	MA	Active
DSH220071BW	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation/RHEUMATOLOGY ASSOCIATES - MGH RHEUMATOLOGY ASSOCIATES	151 Everett Avenue	Chelsea	MA	Active
DSH220071BX	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH GI Outpatient Clinic - GI Outpatient Clinic	165 Cambridge St.	Boston	MA	Active
DSH220071BXY	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	Mass General Cancer Center at Newton-Wellesley - Oncology	2014 Washington Street	Newton	MA	Approved
DSH220071C	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	MGH CHARLES RIVER PLAZA / Medical Endoscopy	165 CAMBRIDGE ST	BOSTON	MA	Active
DSH220071D	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Yawkey Infusion	32 FRUIT STREET	BOSTON	MA	Active
DSH220071E	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Termeer Infusion Unit	32 FRUIT STREET	BOSTON	MA	Active
DSH220071F	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	The General Hospital Corporation / MGH West Infusion	52 Second Avenue	WALTHAM	MA	Active
DSH220071G	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH West	52 Second Avenue	WALTHAM	MA	Active
DSH220071H	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / ACC Medical Oncology	102 ENDICOTT STREET	DANVERS	MA	Active
DSH220071J	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pulmonary Function Lab	275 CAMBRIDGE STREET	BOSTON	MA	Active
DSH220071K	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Pediatric Respiratory	275 CAMBRIDGE STREET	BOSTON	MA	Active
DSH220071L	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Bone Marrow Transplant Practice	32 FRUIT STREET	BOSTON	MA	Active
DSH220071M	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / GI Lab	32 FRUIT STREET	BOSTON	MA	Terminated
DSH220071N	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Lymphoma	32 FRUIT STREET	BOSTON	MA	Active
DSH220071P	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Connective Tissue Oncology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071Q	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / GYN Oncology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071R	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH GU Cancer Center	32 FRUIT STREET	BOSTON	MA	Active
DSH220071S	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH GI Cancer Center	32 FRUIT STREET	BOSTON	MA	Active
DSH220071T	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / MGH Thoracic Oncology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071U	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Breast Oncology Center	32 FRUIT STREET	BOSTON	MA	Active
DSH220071V	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Bone Marrow Transplant Clinic	32 FRUIT STREET	BOSTON	MA	Active
DSH220071W	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Brain Tumor Center	32 FRUIT STREET	BOSTON	MA	Active
DSH220071X	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Head and Neck Oncology	32 FRUIT STREET	BOSTON	MA	Active
DSH220071Y	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Center for Melanoma	32 FRUIT STREET	BOSTON	MA	Active
DSH220071Z	Child	DSH	MASSACHUSETTS GENERAL HOSPITAL	THE GENERAL HOSPITAL CORPORATION / Adolescent Program	32 FRUIT STREET	BOSTON	MA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 8:53:36 AM	9/5/2024 11:38:47 AM	9/5/2024 11:38 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 8:45:57 AM	9/5/2023 8:53:36 AM	9/5/2023 8:53 AM
Details	Last Recertification Date	Update	Recertification	9/1/2021 1:59:48 PM	9/1/2022 8:45:57 AM	9/1/2022 8:45 AM
Details	Last Recertification Date	Update	Recertification		9/1/2021 1:59:48 PM	9/1/2021 1:59 PM
Details	State	Update	OPA Edit	Approved	Active	3/24/2021 8:07 PM
Dates	Start Date	Update	OPA Edit	4/1/2021 12:00:00 AM	3/24/2021 12:00:00 AM	3/24/2021 8:07 PM
Medicaid Billing	NPI: Number	Insert	Reinstatement		1023049236	3/24/2021 6:49 AM
Medicaid Billing	NPI: State	Insert	Reinstatement		MA	3/24/2021 6:49 AM
Medicaid Billing	NPI: Number	Delete	Reinstatement	1023049236 ( )		3/24/2021 6:49 AM
Details	Last Recertification Date	Update	Reinstatement	9/11/2019 4:22:31 PM		3/24/2021 6:49 AM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	1/1/2020 12:00:00 AM		3/24/2021 6:49 AM
Dates	Participating Approval Date	Update	Reinstatement	7/25/2017 12:00:00 AM	3/24/2021 6:49:14 AM	3/24/2021 6:49 AM
Details	State	Update	Reinstatement	Terminated	Approved	3/24/2021 6:49 AM
Dates	Registration Date	Update	Reinstatement	7/12/2017 12:00:00 AM	3/16/2021 4:34:51 PM	3/24/2021 6:49 AM
Dates	Signed By Date	Update	Reinstatement	7/12/2017 12:00:00 AM	3/23/2021 9:41:08 AM	3/24/2021 6:49 AM
Dates	Start Date	Update	Reinstatement	10/1/2017 12:00:00 AM	4/1/2021 12:00:00 AM	3/24/2021 6:49 AM
Terminations	Termination Date	Update	Reinstatement	1/1/2020 12:00:00 AM		3/24/2021 6:49 AM
Terminations	Termination Effective Date	Update	Reinstatement	1/1/2020 12:00:00 AM		3/24/2021 6:49 AM
Terminations	Termination Reason	Update	Reinstatement	Change of covered entity type		3/24/2021 6:49 AM
Details	Comments Public	Insert	Reinstatement		Participated starting 10/1/2017, terminated 1/1/2020. Reinstated 4/1/2021.	3/23/2021 11:59 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		1/1/2020 12:00:00 AM	11/7/2019 12:35 PM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	11/7/2019 12:35 PM
Terminations	Termination Date	Update	Hospital Type Change Request		1/1/2020 12:00:00 AM	11/7/2019 12:35 PM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		1/1/2020 12:00:00 AM	11/7/2019 12:35 PM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	11/7/2019 12:35 PM
Details	Last Recertification Date	Update	Recertification	9/6/2018 3:20:22 PM	9/11/2019 4:22:31 PM	9/11/2019 4:22 PM
Details	Last Recertification Date	Update	Recertification	11/3/2017 12:40:31 PM	9/6/2018 3:20:22 PM	9/6/2018 3:20 PM
Details	Last Recertification Date	Update	Recertification		11/3/2017 12:40:31 PM	11/3/2017 12:40 PM
Contacts	Authorizing Official	Update		Boemer, Sally Mason Senior Vice President of Finance 6177244537	Boemer, Sally Mason Senior Vice President of Finance Mass General Hospital 6177244537	10/12/2017 1:06 PM
Contacts	Signed By	Update		Boemer, Sally Mason Senior Vice President of Finance 6177244537	Boemer, Sally Mason Senior Vice President of Finance Mass General Hospital 6177244537	10/12/2017 1:06 PM
Contacts	Primary Contact	Update		Nehme, Rafic Director, Pharmacy Business & Finance 6177265125	Nehme, Rafic Director, Pharmacy Business & Finance Massachusetts General Hospital 6177265125	9/28/2017 11:01 AM
Contacts	Authorizing Official	Insert			Boemer, Sally Mason Senior Vice President of Finance 6177244537	8/8/2017 8:30 AM
Contacts	Signed By	Insert			Boemer, Sally Mason Senior Vice President of Finance 6177244537	8/8/2017 8:30 AM
Addresses	Main Address	Insert			165 CAMBRIDGE STREET MGH CHARLES RIVER PLAZA BOSTON, MA 02114-2783	7/25/2017 12:27 PM
Contacts	Primary Contact	Insert			Nehme, Rafic Director, Pharmacy Business & Finance 6177265125	7/25/2017 12:27 PM
Details	State	Update		Approved	Active	7/25/2017 12:27 PM
Dates	Participating Approval Date	Update			7/25/2017 12:00:00 AM	7/25/2017 12:27 PM
Details	State	Update		Pending	Approved	7/25/2017 12:27 PM
Dates	Start Date	Update			10/1/2017 12:00:00 AM	7/25/2017 12:27 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_78343	DSH220071BJ	7/13/2017 12:41 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_78343	7/12/2017 11:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/12/2017 11:37 AM
Medicaid Billing	Medicaid: Number	Insert			110001958	7/12/2017 11:37 AM
Medicaid Billing	Medicaid: State	Insert			MA	7/12/2017 11:37 AM
Medicaid Billing	NPI: Number	Insert			1023049236	7/12/2017 11:37 AM
Details	Last Recertification Date	Insert				7/12/2017 11:37 AM
Details	Grant Number	Insert				7/12/2017 11:37 AM
Details	340B ID	Insert				7/12/2017 11:37 AM
Details	Is Authorizing Official EHB Data	Insert				7/12/2017 11:37 AM
Dates	Last Date That 340B Drugs Purchased	Insert				7/12/2017 11:37 AM
Details	Medicare Provider Number	Insert			220071	7/12/2017 11:37 AM
Details	Entity Name	Insert			MASSACHUSETTS GENERAL HOSPITAL	7/12/2017 11:37 AM
Details	Program Code	Insert			DSH	7/12/2017 11:37 AM
Details	Entity Subname	Insert			THE GENERAL HOSPITAL CORPORATION / Electroencephalography EEG	7/12/2017 11:37 AM
Dates	Participating Approval Date	Insert				7/12/2017 11:37 AM
Details	State	Insert			Pending	7/12/2017 11:37 AM
Dates	Registration Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 11:37 AM
Dates	Signed By Date	Insert			7/12/2017 12:00:00 AM	7/12/2017 11:37 AM
Dates	Start Date	Insert				7/12/2017 11:37 AM
Terminations	Termination Comments	Insert				7/12/2017 11:37 AM
Terminations	Termination Date	Insert				7/12/2017 11:37 AM
Terminations	Termination Effective Date	Insert				7/12/2017 11:37 AM
Terminations	Termination Reason	Insert				7/12/2017 11:37 AM