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RRC070021-00 Windham Community Memorial Hospital (Terminated)
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Main Details
Name
Windham Community Memorial Hospital
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC070021-00
Medicare Provider Number
070021
Additional Details
Current Program Status
Terminated
Registration Date
8/31/2011
Participating Start Date
10/1/2011
Participating Approval Date
9/27/2011
Last Recertification Date
11/17/2017
Termination Date
Termination Reason
7/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Hartford HealthCare
Anthony Mastroianni, Regional Vice President, Finance
(860) 889-8331 Ext: 2311
Primary Contact
Backus and WIndham Hospitals
Nicholas Tessier, Director of Pharmacy
(860) 885-6435
Addresses
Street Address
112 Mansfield Avenue
Willimantic, CT 06226
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/23/12 update mailing address from 122 Mansfield Avenue Willimantic, CT 06226 10/19/11 Initially approved with erroneous start date of 1/1/12, on 10/3/11 updated start date to the value it should have had: 10/1/11;
02/23/2012
10/19/11 Initially approved with erroneous start date of 1/1/12, on 10/3/11 updated start date to the value it should have had: 10/1/11;
10/19/2011
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