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DSH220116A TUFTS MEDICAL CENTER (Terminated)
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Main Details
Name
TUFTS MEDICAL CENTER
Subdivision Name
South Boston Day Hospital
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220116A
Medicare Provider Number
220116
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/11/2013
Last Recertification Date
8/26/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Tufts Medical Center
Kristine Hanscom, CFO
(617) 636-7767
Primary Contact
Tufts Medical Center
Ross Thompson, VP, Clinical Operations
(617) 636-4663
Addresses
Street Address
58 Old Colony Ave
South Boston, MA 02127
Billing Address
Tufts Medical Center
800 Washington Street
Boston, MA 02111
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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