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RRC070007-00 Lawrence & Memorial Hospital (Terminated)
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Main Details
Name
Lawrence & Memorial Hospital
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC070007-00
Medicare Provider Number
070007
Additional Details
Current Program Status
Terminated
Registration Date
2/28/2018
Participating Start Date
4/1/2018
Participating Approval Date
3/1/2018
Last Recertification Date
9/9/2018
Termination Date
Termination Reason
7/1/2019
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Yale New Haven Health System
Douglas Payne, Director, Reimbursement Yale New Haven Health System
(203) 688-4878
Primary Contact
Yale New Haven Health System
Mary G Messina, Director, Regulatory Reimbursement YNHHS
(203) 688-8543
Addresses
Street Address
365 Montauk Ave
New London, CT 06320
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2014, terminated 10/1/2014. Reinstated 4/1/2018.
03/01/2018
Participated starting 1/1/2014, terminated 10/1/2014. Reinstated effective immediately 3/1/2018.
03/01/2018
April 2025
April 2025
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