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DSH220033A BEVERLY HOSPITAL (Active)
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Main Details
Name
BEVERLY HOSPITAL
Subdivision Name
ADDISON GILBERT HOSPITAL
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220033A
Medicare Provider Number
220033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/10/2010
Participating Start Date
7/1/2013
Participating Approval Date
6/27/2013
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
Beverly Hospital
Gregory Beaumier, CFO - Beverly Hospital
(978) 816-2587
Primary Contact
BILH
Jennifer Rossi, 340B Director of Compliance and Advocacy
(207) 266-9127
Addresses
Street Address
298 WASHINGTON ST.
GLOUCESTER, MA 01930
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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6/26/13 participating 4/1/10 thru 6/30/12, not participating 7/1/12 thru 6/30/13, reinstated based on new registration submitted; 12/14/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
06/26/2013
12/14/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
03/26/2010
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