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DSH220011K CAMBRIDGE PUBLIC HEALTH COMMISSION (Terminated)
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Main Details
Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
UNION SQUARE HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220011K
Medicare Provider Number
220011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/17/2005
Participating Start Date
11/17/2005
Participating Approval Date
11/17/2005
Last Recertification Date
8/25/2015
Termination Date
Termination Reason
1/1/2016
Site closure
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
337 SOMERVILLE AVENUE
SOMERVILLE, MA 02143
Billing Address
CHA Outpatient Pharmacy
1493 Cambridge Street
Cambridge, MA 02139
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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