340B Drug Pricing Program Database


DSH220086CG BETH ISRAEL DEACONESS MEDICAL CENTER (Active) - information as of 5/9/2025 10:41:47 PM

Main Details
BETH ISRAEL DEACONESS MEDICAL CENTER
Beth Israel Deaconess Medical Center - PACU/SDS-West
Disproportionate Share Hospital
Yes
DSH220086CG
220086


Additional Details
Active
5/7/2024
7/1/2024
5/19/2024
8/30/2024

Contacts

BIDMC
Matthew Larkin, Chief Operating Officer
(617) 677-7144

BILH
Jennifer Rossi, 340B Director of Compliance and Advocacy
(207) 266-9127

Addresses

1 Deaconess Rd
Boston, MA 02215

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 4/1/2020, Terminated 4/1/2021, Reinstated 7/1/202405/17/2024
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
MA110000014C,110000014D,110000014A1548202641
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH220086AChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CENTER230 BOWDOIN ST.DORCHESTERMATerminated
DSH220086AAChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - INFECTIOUS DISEASE CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086ABChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - CARDIAC SURGERY CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086ACChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - ORTHOPEDICS CLINIC482 Bedford St.LEXINGTONMAActive
DSH220086ADChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - PHYSICAL THERAPY SERVICES482 BEDFORD STREETLEXINGTONMAActive
DSH220086AEChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - OCCUPATIONAL THERAPY SERVICES482 BEDFORD STREETLEXINGTONMAActive
DSH220086AFChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CENTER - PHYSICAL THERAPY230 BOWDOIN STREETDORCHESTERMAActive
DSH220086AGChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - OB/GYN CLINIC1000 BROADWAY STREETCHELSEAMAActive
DSH220086AHChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - OPTOMETRY SERVICES482 BEDFORD STREETLEXINGTONMAActive
DSH220086AJChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CENTER - PODIATRY CLINIC230 BOWDOIN STREETDORCHESTERMATerminated
DSH220086AKChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - RADIOLOGY SERVICES1000 BROADWAY STREETCHELSEAMAActive
DSH220086ALChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - PHYSICAL THERAPY1000 BROADWAY STREETCHELSEAMAActive
DSH220086AMChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - ADULT MEDICINE CLINIC1000 BROADWAY STREETCHELSEAMAActive
DSH220086ANChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - URGENT CARE - CHELSEA1000 BROADWAY STREETCHELSEAMAActive
DSH220086APChildDSHBETH ISRAEL DEACONESS MEDICAL CENTEROne Bookline Place - GERONTOLOGY CLINICOne Brookline PlaceBrooklineMAActive
DSH220086AQChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - LAB SERVICES482 BEDFORD STREETLEXINGTONMATerminated
DSH220086ARChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - LABORATORY SERVICES1000 BROADWAY STREETCHELSEAMATerminated
DSH220086ASChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - OPTOMETRY CLINIC1000 BROADWAY STREETCHELSEAMAActive
DSH220086ATChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - PFT CLINIC1000 BROADWAY STREETCHELSEAMAActive
DSH220086AUChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - NEUROSURGERY CLINIC110 FRANCIS STREETBostonMAActive
DSH220086AVChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - MEDICINE SPECIALTY CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086AWChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - ADULT SPECIALTY CLINIC1000 BROADWAY STREETCHELSEAMAActive
DSH220086AXChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - ENDOSCOPY SERVICES482 BEDFORD STREETLEXINGTONMAActive
DSH220086AYChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - ALLERGY CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086AZChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - TRANSPLANT CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086BChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH1000 BROADWAYCHELSEAMATerminated
DSH220086BAChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - GENERAL SURGERY CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086BBChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - DERMATOLOGY CLINIC482 BEDFORD STREETLEXINGTONMATerminated
DSH220086BCChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - NEUROLOGY CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086BDChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - PODIATRY CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086BEChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CENTER - MEDICINE230 BOWDOIN STDORCHESTERMAActive
DSH220086BFChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - DERMATOLOGY CLINIC1000 BROADWAY STREETCHELSEAMAActive
DSH220086BGChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - MEDICINE ALLERGY CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086BHChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - OTOLARYNGOLOGY CLINIC110 FRANCIS STREETBOSTONMATerminated
DSH220086BJChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - VASCULAR LAB110 FRANCIS STREETBOSTONMAActive
DSH220086BKChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - OB/GYN CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086BLChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - PFT CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086BMChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CLINIC - PSYCHIATRY CLINIC230 BOWDOIN STREETDORCHESTERMAActive
DSH220086BNChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - PLASTIC SURGERY CLINIC110 FRANCIS STREETBOSTONMATerminated
DSH220086BPChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - LIVER CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086BQChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - SURGERY CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086BRChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - BREAST IMAGING CENTER482 BEDFORD STREETLEXINGTONMAActive
DSH220086BSChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - RHEUMATOLOGY CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086BTChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - INFUSION CENTER482 BEDFORD STREETLEXINGTONMAActive
DSH220086BUChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - ULTRASOUND SERVICES482 BEDFORD STREETLEXINGTONMAActive
DSH220086BVChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CENTER - PEDIATRIC CLINIC230 BOWDOIN STREETDORCHESTERMAActive
DSH220086BWChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - VOICE,SPEECH,SWALLOW1 Deaconess RdBostonMAActive
DSH220086BXChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - HOLTER LAB1 Deaconess RdBostonMAActive
DSH220086BYChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - RADIOLOGY MRI1 Deaconess RdBostonMAActive
DSH220086BZChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - CDAC Outpatient1 Deaconess RdBostonMAActive
DSH220086CChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON482 BEDFORD STREETLEXINGTONMATerminated
DSH220086CAChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Thoracic Clinic1 Deaconess RdBostonMAActive
DSH220086CBChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - ANESTHESIA1 Deaconess RdBostonMATerminated
DSH220086CCChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - EXERCISE LAB1 Deaconess RdBostonMAActive
DSH220086CDChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - RAD NEUROINTERV1 Deaconess RdBostonMAActive
DSH220086CEChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - West Specialty Clinic WSC1 Deaconess RdBostonMAActive
DSH220086CFChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Radiology Nursing1 Deaconess RdBostonMAActive
DSH220086CGChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - PACU/SDS-West1 Deaconess RdBostonMAActive
DSH220086CHChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - RAD ANGIOGRAPHY1 Deaconess RdBostonMAActive
DSH220086CJChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - RADIOLOGY CAT SCAN1 Deaconess RdBostonMAActive
DSH220086CKChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Pancreas Multidisciplinary Clinic1 Deaconess RdBostonMATerminated
DSH220086CLChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - EEG LAB1 Deaconess RdBostonMAActive
DSH220086CMChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - CARDIAC CATH LAB1 Deaconess RdBostonMAActive
DSH220086CNChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - VENOUS ACCESS TEAM1 Deaconess RdBostonMATerminated
DSH220086CPChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Psych Clinic1 Deaconess RdBostonMATerminated
DSH220086CQChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Emergency Unit1 Deaconess RdBostonMAActive
DSH220086CRChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Gerontology Clinic1 Deaconess RdBostonMATerminated
DSH220086CSChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - PODIATRY-West1 Deaconess RdBostonMAActive
DSH220086CTChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - ELECTROPHYSIOLOGY UNIT1 Deaconess RdBostonMAActive
DSH220086CUChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - RADIOLOGY GENERAL DIAGNOSTICS1 Deaconess RdBostonMAActive
DSH220086CVChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Wound/Ostomy Clinic1 Deaconess RdBostonMATerminated
DSH220086CWChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - WEST PROCEDURAL CENTER1 Deaconess RdBostonMAActive
DSH220086CXChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - BLOOD BANK1 Deaconess RdBostonMATerminated
DSH220086CYChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Nephrology Clinic1 Deaconess RdBostonMAActive
DSH220086CZChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - RADIOLOGY ULTRASOUND1 Deaconess RdBostonMAActive
DSH220086DChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERWest CampusONE DEACONESS ROADBOSTONMATerminated
DSH220086DAChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - ECHO LAB1 Deaconess RdBostonMAActive
DSH220086DBChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Radiology Nuclear Medicine1 Deaconess RdBostonMATerminated
DSH220086DCChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - AUTONOMIC LAB1 Deaconess RdBostonMAActive
DSH220086DDChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - OR-West1 Deaconess RdBostonMAActive
DSH220086DEChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - REHAB (PT/OT)1 Deaconess RdBostonMAActive
DSH220086DFChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - ECT SB1 Deaconess RdBostonMAActive
DSH220086DGChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERGASTROENTEROLOGY - WEST - GI Clinic110 Francis StBostonMAActive
DSH220086DHChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERDEVICES CLINIC - Device RemoteOne Deaconess RoadBostonMAActive
DSH220086DJChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERSurgical Associates LMOB NP - Surgical Associates LMOB NP110 Francis StBostonMAActive
DSH220086DKChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBIDMC INFUSION SERVICES AT LAHEY HO - BIDMC Infusion Services at LHMC-Burlington41 MALL RDBURLINGTONMAActive
DSH220086DLChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBIDMC INFUSION SERVICES AT LAHEY PE - BIDMC Infusion Services at LHMC-Peabody1 ESSEX CENTER DRPEABODYMAActive
DSH220086DMChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Medical Center - Prophylactic MAB Clinic1 Deaconess RdBostonMATerminated
DSH220086DNChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess Healthcare - Chestnut Hill - Optometry200 Boylston StreetNewtonMAActive
DSH220086DPChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERKlarman - BIDMC Pre-OP - West111 Francis St.BostonMAActive
DSH220086DQChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERKlarman - Cardiac Intermediate Care111 Francis St.BostonMAActive
DSH220086DRChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERKlarman - Cardiothoracic surgery111 Francis St.BostonMAActive
DSH220086DSChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERThe Cancer Center at Beth Israel Deaconess Medical Center - Physical Therapy148 Chestnut St.NeedhamMAActive
DSH220086DTChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERKlarman - Cardiac medicine111 Francis St.BostonMAActive
DSH220086DUChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERJoslin - Diabetes1 Joslin PlBostonMAActive
DSH220086DVChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERFeldberg - Intravenous therapy330 Brookline Ave.BostonMAActive
DSH220086DWChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBIDMC West Campus - Crisis Stabilization UnitOne Deaconess RoadBostonMAActive
DSH220086DXChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBIDMC Winchester HemOnc620 Washington StreetWinchesterMAActive
DSH220086DYChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBETH ISRAEL DEACONESS MEDICAL CENTE - HEMONC INFUSION330 BROOKLINE AVEBOSTONMAActive
DSH220086EChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERARNOLD PAIN MANAGEMENT CENTERONE BROOKLINE PLACEBROOKLINEMAActive
DSH220086FChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess HealthCare - Chestnut Hill / Lab Services at Chestnut Hill200 Boylston StreetNewtonMATerminated
DSH220086GChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERThe Cancer Center at Beth Israel Deaconess Medical Center - Needham / Hem/Onc - BID Cancer Center Needham148 Chestnut StNeedhamMAActive
DSH220086HChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess HealthCare - Chestnut Hill / Urgent Care200 Boylston StreetNewtonMAActive
DSH220086JChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess HealthCare - Chestnut Hill / Outpatient Rehab at Chestnut Hill200 Boylston StreetNewtonMAActive
DSH220086KChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess HealthCare - Chestnut Hill / Radiology at Chestnut Hill Square200 Boylston StreetNewtonMAActive
DSH220086LChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess HealthCare - Chestnut Hill / Med/Surg Specialty200 Boylston StreetNewtonMAActive
DSH220086MChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess HealthCare - Chestnut Hill / Ob / Gyn Clinic200 Boylston StreetNewtonMAActive
DSH220086NChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBeth Israel Deaconess HealthCare - Chestnut Hill / Sports Medicine200 Boylston StreetNewtonMAActive
DSH220086PChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERThe Cancer Center at Beth Israel Deaconess Medical Center - Needham / Lab Services At Cancer Center - Needham148 Chestnut StNeedhamMATerminated
DSH220086QChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERThe Cancer Center at Beth Israel Deaconess Medical Center - Needham / Radiation Oncology 148 Chestnut StNeedhamMAActive
DSH220086RChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERThe Cancer Center at Beth Israel Deaconess Medical Center - Needham / Med/Surg Specialty 148 Chestnut StNeedhamMAActive
DSH220086SChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - RADIOLOGY SERVICES482 BEDFORD STREETLEXINGTONMAActive
DSH220086TChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - GI OFFICE482 BEDFORD STREETLEXINGTONMAActive
DSH220086UChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER NORTH - PODIATRY CLINIC1000 BROADWAY STREETCHELSEAMAActive
DSH220086VChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - VASCULAR SURGERY CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086WChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERLOWRY MEDICAL OFFICE - ENDOCRINOLOGY CLINIC110 FRANCIS STREETBOSTONMAActive
DSH220086XChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERMEDICAL CARE CENTER OF LEXINGTON - CARDIOLOGY CLINIC482 BEDFORD STREETLEXINGTONMAActive
DSH220086YChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CENTER - OB/GYN CLINIC230 BOWDOIN STREETDORCHESTERMAActive
DSH220086ZChildDSHBETH ISRAEL DEACONESS MEDICAL CENTERBOWDOIN STREET HEALTH CENTER - OPTOMETRY CLINIC230 BOWDOIN STREETDORCHESTERMAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdatePC Change RequestWood, Shawn J Director of System 340B Oversight Beth Israel Lahey Health 7813526685Rossi, Jennifer 340B Director of Compliance and Advocacy BILH 20726691271/14/2025 1:33 PM
DetailsLast Recertification DateUpdateRecertification 8/30/2024 8:22:06 AM8/30/2024 8:22 AM
DetailsStateUpdate ApprovedActive7/1/2024 12:01 AM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False5/19/2024 8:22 AM
Medicaid BillingMedicaid: NumberInsertReinstatement 110000014A5/19/2024 8:22 AM
Medicaid BillingMedicaid: StateInsertReinstatement MA5/19/2024 8:22 AM
ContactsAuthorizing OfficialUpdateReinstatementCullen, Michael CFO Beth Israel Deaconess Medical Center 6176677146Larkin, Matthew Chief Operating Officer BIDMC 61767771445/19/2024 8:22 AM
ContactsSigned ByUpdateReinstatementCullen, Michael CFO Beth Israel Deaconess Medical Center 6176677146Larkin, Matthew Chief Operating Officer BIDMC 61767771445/19/2024 8:22 AM
DetailsLast Recertification DateUpdateReinstatement9/5/2020 12:15:14 AM 5/19/2024 8:22 AM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement4/1/2021 12:00:00 AM 5/19/2024 8:22 AM
DatesParticipating Approval DateUpdateReinstatement2/11/2020 1:23:41 PM5/19/2024 8:22:41 AM5/19/2024 8:22 AM
DetailsStateUpdateReinstatementTerminatedApproved5/19/2024 8:22 AM
DatesRegistration DateUpdateReinstatement1/2/2020 11:33:44 AM5/7/2024 2:08:13 PM5/19/2024 8:22 AM
DatesSigned By DateUpdateReinstatement1/6/2020 10:49:28 AM5/8/2024 8:03:51 AM5/19/2024 8:22 AM
DatesStart DateUpdateReinstatement4/1/2020 12:00:00 AM7/1/2024 12:00:00 AM5/19/2024 8:22 AM
TerminationsTermination CommentsUpdateReinstatementIn keeping registrations for separate cost centers for child-sites, we are going to terminate locations/cost center that do not represent services patients are scheduled for. Example patients for this service are scheduled for the OR  5/19/2024 8:22 AM
TerminationsTermination DateUpdateReinstatement4/1/2021 12:00:00 AM 5/19/2024 8:22 AM
TerminationsTermination Effective DateUpdateReinstatement4/1/2021 12:00:00 AM 5/19/2024 8:22 AM
TerminationsTermination ReasonUpdateReinstatementOther 5/19/2024 8:22 AM
DetailsComments PublicInsertReinstatement Participated starting 4/1/2020, Terminated 4/1/2021, Reinstated 7/1/20245/17/2024 2:30 PM
ContactsPrimary ContactUpdateProfile Change RequestWood, Shawn J 340B Hospital Program Manager Beth Israel Deaconess Medical Center 6177543835Wood, Shawn J Director of System 340B Oversight Beth Israel Lahey Health 78135266853/27/2023 6:20 AM
DetailsStateUpdate To Be TerminatedTerminated4/1/2021 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 4/1/2021 12:00:00 AM1/12/2021 8:01 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated1/12/2021 8:01 AM
TerminationsTermination CommentsUpdateTermination Request In keeping registrations for separate cost centers for child-sites, we are going to terminate locations/cost center that do not represent services patients are scheduled for. Example patients for this service are scheduled for the OR 1/12/2021 8:01 AM
TerminationsTermination DateUpdateTermination Request 4/1/2021 12:00:00 AM1/12/2021 8:01 AM
TerminationsTermination Effective DateUpdateTermination Request 4/1/2021 12:00:00 AM1/12/2021 8:01 AM
TerminationsTermination ReasonUpdateTermination Request Other1/12/2021 8:01 AM
Medicaid BillingMedicaid: NumberDeleteRecertificationXHSP40986 (CA) 9/5/2020 12:15 AM
Medicaid BillingMedicaid: NumberDeleteRecertification3032430 (CT) 9/5/2020 12:15 AM
Medicaid BillingMedicaid: NumberDeleteRecertification042103881 (ME) 9/5/2020 12:15 AM
Medicaid BillingMedicaid: NumberDeleteRecertification99220086 (NH) 9/5/2020 12:15 AM
Medicaid BillingMedicaid: NumberDeleteRecertification00350490 (NY) 9/5/2020 12:15 AM
Medicaid BillingMedicaid: NumberDeleteRecertificationOP20086 (RI) 9/5/2020 12:15 AM
Medicaid BillingMedicaid: NumberDeleteRecertification99220086 (RI) 9/5/2020 12:15 AM
Medicaid BillingMedicaid: NumberDeleteRecertification99220086 (VT) 9/5/2020 12:15 AM
Medicaid BillingNPI: NumberDeleteRecertification1548202641 ( ) 9/5/2020 12:15 AM
Medicaid BillingNPI: NumberInsertRecertification 15482026419/5/2020 12:15 AM
Medicaid BillingNPI: StateInsertRecertification MA9/5/2020 12:15 AM
ContactsPrimary ContactUpdateRecertificationWood, Shawn Pharmacy 340B and Inventory Supervisor Beth Israel Deaconess Medical Center 6177543835Wood, Shawn J 340B Hospital Program Manager Beth Israel Deaconess Medical Center 61775438359/5/2020 12:15 AM
DetailsLast Recertification DateUpdateRecertification 9/5/2020 12:15:14 AM9/5/2020 12:15 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestCullen, Mike CFO Beth Israel Deaconess Medical Center 6176320155Cullen, Michael CFO Beth Israel Deaconess Medical Center 61766771468/26/2020 6:06 AM
ContactsSigned ByUpdateProfile Change RequestCullen, Mike CFO Beth Israel Deaconess Medical Center 6176320155Cullen, Michael CFO Beth Israel Deaconess Medical Center 61766771468/26/2020 6:06 AM
DetailsStateUpdate ApprovedActive4/1/2020 12:05 AM
ContactsSigned ByInsertNew Registration Cullen, Mike CFO Beth Israel Deaconess Medical Center 61763201552/11/2020 1:23 PM
Details340B IDUpdateNew Registration DSH220086CG2/11/2020 1:23 PM
DetailsEntity SubnameUpdateNew RegistrationBeth Israel Deaconess Medical CenterBeth Israel Deaconess Medical Center - PACU/SDS-West2/11/2020 1:23 PM
DatesParticipating Approval DateUpdateNew Registration 2/11/2020 1:23:41 PM2/11/2020 1:23 PM
DetailsStateUpdateNew RegistrationPendingApproved2/11/2020 1:23 PM
DatesSigned By DateUpdateNew Registration 1/6/2020 10:49:28 AM2/11/2020 1:23 PM
DatesStart DateUpdateNew Registration 4/1/2020 12:00:00 AM2/11/2020 1:23 PM
AddressesMain AddressInsertNew Registration  1 Deaconess Rd Boston, MA 022151/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 110000014C1/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration MA1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 110000014D1/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration MA1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration XHSP409861/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration CA1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 30324301/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration CT1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 0421038811/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration ME1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 992200861/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration NH1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 003504901/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration NY1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration OP200861/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration RI1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 992200861/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration RI1/2/2020 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False1/2/2020 11:33 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 992200861/2/2020 11:33 AM
Medicaid BillingMedicaid: StateInsertNew Registration VT1/2/2020 11:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 15482026411/2/2020 11:33 AM
ContactsAuthorizing OfficialInsertNew Registration Cullen, Mike CFO Beth Israel Deaconess Medical Center 61763201551/2/2020 11:33 AM
ContactsPrimary ContactInsertNew Registration Wood, Shawn Pharmacy 340B and Inventory Supervisor Beth Israel Deaconess Medical Center 61775438351/2/2020 11:33 AM
DetailsLast Recertification DateInsertNew Registration  1/2/2020 11:33 AM
DetailsGrant NumberInsertNew Registration  1/2/2020 11:33 AM
Details340B IDInsertNew Registration  1/2/2020 11:33 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/2/2020 11:33 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/2/2020 11:33 AM
DetailsMedicare Provider NumberInsertNew Registration 2200861/2/2020 11:33 AM
DetailsEntity NameInsertNew Registration BETH ISRAEL DEACONESS MEDICAL CENTER1/2/2020 11:33 AM
DetailsProgram CodeInsertNew Registration DSH1/2/2020 11:33 AM
DetailsEntity SubnameInsertNew Registration Beth Israel Deaconess Medical Center1/2/2020 11:33 AM
DatesParticipating Approval DateInsertNew Registration  1/2/2020 11:33 AM
DetailsStateInsertNew Registration Pending1/2/2020 11:33 AM
DatesRegistration DateInsertNew Registration 1/2/2020 11:33:44 AM1/2/2020 11:33 AM
DatesSigned By DateInsertNew Registration  1/2/2020 11:33 AM
DatesStart DateInsertNew Registration  1/2/2020 11:33 AM
TerminationsTermination CommentsInsertNew Registration  1/2/2020 11:33 AM
TerminationsTermination DateInsertNew Registration  1/2/2020 11:33 AM
TerminationsTermination Effective DateInsertNew Registration  1/2/2020 11:33 AM
TerminationsTermination ReasonInsertNew Registration  1/2/2020 11:33 AM