340B Drug Pricing Program Database
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DSH220035U NORTH SHORE MEDICAL CENTER (Terminated)
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Main Details
Name
NORTH SHORE MEDICAL CENTER
Subdivision Name
NSMC Outpatient Mental Health at Union Hospital / MH Hartman Hall Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220035U
Medicare Provider Number
220035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/29/2015
Last Recertification Date
11/7/2019
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
North Shore Medical Center
Charles E Adams, Executive Director, Finance
(978) 354-4000
Primary Contact
North Shore Medical Center
Ralph Michael McHatton, Director Pharmacy
(978) 354-2358
Addresses
Street Address
490 Lynnfield Street
1st Floor
Lynn, MA 01904
Billing Address
North Shore Medical Center Union Hospital
500 Lynnfield Street
Lynn, MA 01904
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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