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DSH220163CV UMASS MEMORIAL MEDICAL CENTER (Active)
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Main Details
Name
UMASS MEMORIAL MEDICAL CENTER
Subdivision Name
Pediatrics Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220163CV
Medicare Provider Number
220163
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/6/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/20/2016
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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