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DSH220074G SOUTHCOAST HOSPITALS GROUP INC (Terminated)
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Main Details
Name
SOUTHCOAST HOSPITALS GROUP INC
Subdivision Name
SOUTHCOAST SURGERY CENTER - ASC (NON-DISTINCT PART) - ASU Faunce Corner
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220074G
Medicare Provider Number
220074
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/15/2015
Last Recertification Date
8/18/2016
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
Southcoast Health
Renee Clark, Exec. Vice President & Chief Operating Officer
(508) 973-5872
Primary Contact
Southcoast Hospitals Group
Jillian Anderson, Manager - 340B Program & Supply Chain
(508) 973-5951
Addresses
Street Address
300D FAUNCE CORNER RD
NORTH DARTMOUTH, MA 02747
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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