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DSH220011T CAMBRIDGE PUBLIC HEALTH COMMISSION (Active)
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Main Details
Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
CHA Revere Care Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220011T
Medicare Provider Number
220011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/17/2005
Participating Start Date
11/17/2005
Participating Approval Date
11/17/2005
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
454 BROADWAY
REVERE, MA 02151
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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