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DSH220033E BEVERLY HOSPITAL (Terminated)
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Main Details
Name
BEVERLY HOSPITAL
Subdivision Name
NORTH SHORE BIRTHING CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220033E
Medicare Provider Number
220033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/10/2010
Participating Start Date
4/1/2013
Participating Approval Date
3/19/2013
Last Recertification Date
9/15/2022
Termination Date
Termination Reason
7/1/2023
Site closure
Contacts
Authorizing Official
Northeast Hospital
Tom Sands, President
(978) 816-2580
Primary Contact
220033
Hope Violette, Director of Pharmacy
(978) 922-3000 Ext: 2612
Addresses
Street Address
79 HERRICK ST.
BEVERLY, MA 01915
Billing Address
Beverly Hosptial
85 Herrick Street
Beverly, MA 01915
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/19/13 participating 4/1/10 thru 6/30/12, not participating 7/1/12 thru 3/31/13, record reinstated based on new registration submitted and electronically signed by Gary Marlow on 1/14/13; 12/14/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
03/19/2013
12/14/09 DOC. RECD. TO CONFIRM DSH ADJ. %.
03/26/2010
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