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DSH410007B RHODE ISLAND HOSPITAL (Terminated)
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Main Details
Name
RHODE ISLAND HOSPITAL
Subdivision Name
Pediatric Physical Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH410007B
Medicare Provider Number
410007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/20/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/10/2012
Last Recertification Date
8/31/2018
Termination Date
Termination Reason
4/1/2019
Other
Contacts
Authorizing Official
Rhode Island Hospital
Mary Wakefield, Senior VP and CFO
(401) 444-7093
Primary Contact
Brown University Health
CHRISTINE COLLINS, SVP, Pharmacy & Periop, Chief Pharmacy Officer
(401) 444-4434
Addresses
Street Address
765 Allens Avenue
Suite 200
Providence, RI 02905
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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