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DSH220086DS BETH ISRAEL DEACONESS MEDICAL CENTER (Active)
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Main Details
Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
The Cancer Center at Beth Israel Deaconess Medical Center - Physical Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220086DS
Medicare Provider Number
220086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/30/2024
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
BIDMC
Matthew Larkin, Chief Operating Officer
(617) 677-7144
Primary Contact
BILH
Jennifer Rossi, 340B Director of Compliance and Advocacy
(207) 266-9127
Addresses
Street Address
148 Chestnut St.
Needham, MA 02492
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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