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DSH220011AD CAMBRIDGE PUBLIC HEALTH COMMISSION (Terminated)
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Main Details
Name
CAMBRIDGE PUBLIC HEALTH COMMISSION
Subdivision Name
The Cambridge Hospital
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220011AD
Medicare Provider Number
220011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/29/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/23/2012
Last Recertification Date
8/21/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Cambridge Public Health Commission
Andrew M Fuqua, Senior Vice President and General Counsel
(617) 665-1000
Primary Contact
Cambridge Public Health Commission
Maria Kossilos, Associate Chief Pharmacy Officer
(617) 806-8505
Addresses
Street Address
1493 Cambridge Street
Cambridge, MA 02139
Billing Address
Cambridge Public Health Commission
CHA Outpatient Pharmacy
1493 Cambridge Street
Cambridge, MA 02139
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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