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DSH220074C SOUTHCOAST HOSPITALS GROUP, INC. (Terminated)
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Main Details
Name
SOUTHCOAST HOSPITALS GROUP, INC.
Subdivision Name
DBA CHARLTON MEMORIAL HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220074C
Medicare Provider Number
220074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/23/2008
Participating Start Date
10/1/2004
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
363 HIGHLAND AVE.
FALL RIVER, MA 02720
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/07- DHS ADJ >11.75%
08/04/2011
4/07- DHS ADJ >11.75%
04/23/2008
June 2025
June 2025
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