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DSH220011A CAMBRIDGE PUBLIC HEALTH COMMISSION (Active)
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Main Details
Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
CHA CAMBRIDGE HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220011A
Medicare Provider Number
220011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/1/2003
Participating Start Date
7/1/2003
Participating Approval Date
5/21/2004
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Cambridge Public Health Commission
Andrew M Fuqua, Senior Vice President and General Counsel
(617) 665-1000
Primary Contact
Cambridge Public Health Commission
Maria Kossilos, Associate Chief Pharmacy Officer
(617) 806-8505
Addresses
Street Address
1493 CAMBRIDGE STREET
CAMBRIDGE, MA 02139
Billing Address
Cambridge Public Health Commission
1493 Cambridge Street
CHA Outpatient Pharmacy
Cambridge, MA 02139
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/16/06 - ADDR CHANGE (WAS 120 BEACON ST, 2ND FL, STE 230, SOMERVILLE, MA 02143); 11/16/05 - CORRECTED 340B ID# (CHANGED ID# FROM DSH11559A TO DSH220011A)
07/01/2003
May 2025
May 2025
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