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DSH070010M BRIDGEPORT HOSPITAL (Terminated)
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Main Details
Name
BRIDGEPORT HOSPITAL
Subdivision Name
0014BH HEPATOLOGY PARK AVE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070010M
Medicare Provider Number
070010
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/28/2016
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Yale New Haven Health System
Mary G Messina, Director, Regulatory Reimbursement YNHHS
(203) 688-8543
Primary Contact
Yale New Haven Health Services
Andrew Joseph Esposito, Sr. Reimbursement Analyst
(203) 688-1993
Addresses
Street Address
5520 Park Avenue
Trumbull, CT 06611
Billing Address
Bridgeport Hospital
267 Grant Street
Bridgeport, CT 06610-0120
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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