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DSH070007 LAWRENCE & MEMORIAL HOSPITAL (Active)
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Main Details
Name
LAWRENCE & MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070007
Medicare Provider Number
070007
Additional Details
Current Program Status
Active
Registration Date
4/10/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/1/2019
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Yale New Haven Health Services
Leeann Miller, Chief Pharmacy Officer
(203) 479-3000
Primary Contact
Yale New Haven Health System
Maria Da Silva, Senior Reimbursement Analyst
(203) 688-9332
Addresses
Street Address
365 MONTAUK AVENUE
NEW LONDON, CT 06320-4700
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2016, terminated 2/28/2018. Reinstated 7/1/2019.
04/30/2019
April 2025
April 2025
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