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DSH220074A SOUTHCOAST HOSPITALS GROUP, INC. (Terminated)
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Main Details
Name
SOUTHCOAST HOSPITALS GROUP, INC.
Subdivision Name
Southcoast Center for Cancer Care in Fairhaven
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220074A
Medicare Provider Number
220074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/23/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/23/2008
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Southcoast Health
Renee Clark, Exec. Vice President & Chief Operating Officer
(508) 973-5872
Primary Contact
Southcoast Hospitals Group
Jillian Anderson, Manager - 340B Program & Supply Chain
(508) 973-5951
Addresses
Street Address
206 MILL ROAD
FAIRHAVEN, MA 02719
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/4/11 UPDATED PHYS ADD (WAS 480 HAWTHORN STREET SUITE 101 NORTH DARTMOUTH, MA 02748 ); 4/07- DHS ADJ >11.75%
03/23/2012
8/4/11 UPDATED PHYS ADD (WAS 480 HAWTHORN STREET SUITE 101 NORTH DARTMOUTH, MA 02748 ); 4/07- DHS ADJ >11.75%
08/04/2011
4/07- DHS ADJ >11.75%
04/23/2008
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