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DSH220086C BETH ISRAEL DEACONESS MEDICAL CENTER (Terminated)
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Main Details
Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
MEDICAL CARE CENTER OF LEXINGTON
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220086C
Medicare Provider Number
220086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
9/13/2009
Participating Start Date
10/1/2009
Participating Approval Date
9/21/2009
Last Recertification Date
9/6/2019
Termination Date
Termination Reason
1/1/2020
Other
Contacts
Authorizing Official
Beth Israel Deaconess Medical Center
Michael Cullen, CFO
(617) 667-7146
Primary Contact
Beth Israel Deaconess Medical Center
Shawn Wood, Pharmacy 340B and Inventory Supervisor
(617) 754-3835
Addresses
Street Address
482 BEDFORD STREET
LEXINGTON, MA 02420
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/19/2009- OPA NOTIFIED AUG. 28. 2009- DOC. RECD. TO CONFIRM DSH ADJ. %.09/23/10 UPDATED ADDR. (WAS 1000 BROADWAY STREET)
09/23/2010
April 2025
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