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DSH220163CB UMASS MEMORIAL MEDICAL CENTER (Terminated)
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Main Details
Name
UMASS MEMORIAL MEDICAL CENTER
Subdivision Name
Psych Services Program (Ambulatory Psych)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220163CB
Medicare Provider Number
220163
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
8/23/2018
Termination Date
Termination Reason
4/1/2019
Site closure
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
26 Queens street
Worcester, MA 01610
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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