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DSH220035C NORTH SHORE MEDICAL CENTER (Terminated)
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Main Details
Name
NORTH SHORE MEDICAL CENTER
Subdivision Name
North Shore Medical Center Union Hospital / Union Angio Interv XRay
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220035C
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
11/14/2017
Termination Date
Termination Reason
10/1/2018
Site closure
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
500 Lynnfield Street
Lynn, MA 01904
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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