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DSH220163CF UMASS MEMORIAL MEDICAL CENTER (Active)
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Main Details
Name
UMASS MEMORIAL MEDICAL CENTER
Subdivision Name
University - LUNG/ALLERGY CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220163CF
Medicare Provider Number
220163
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/13/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
UMass Memorial Medical Center
Alice Shakman, Vice President Operations
(774) 443-0540
Primary Contact
UMass Memorial Medical Center
Meetali Desai, 340B Compliance Specialist
(774) 443-2852
Addresses
Street Address
55 Lake Avenue North
Worcester, MA 01655
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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