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DSH220163D UMASS MEMORIAL MEDICAL CENTER (Terminated)
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Main Details
Name
UMASS MEMORIAL MEDICAL CENTER
Subdivision Name
PLUMLEY VILLAGE HEALTH SERVICES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220163D
Medicare Provider Number
220163
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/2/2007
Participating Start Date
1/1/2004
Participating Approval Date
3/2/2007
Last Recertification Date
11/22/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
UMass Memorial Medical Center
Alice Shakman, Vice President Operations
(774) 443-0540
Primary Contact
UMass Memorial Medical Center
Meetali Desai, 340B Compliance Specialist
(774) 443-2852
Addresses
Street Address
116 BELMONT STREET
Suite # 11
WORCESTER, MA 01605
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/12/12 add medicaid/NPI INfo
03/02/2007
8/11/08-NEW ADDRESS (WAS '34 LAUREL STREET')
03/02/2007
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