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DSH070007H LAWRENCE & MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
LAWRENCE & MEMORIAL HOSPITAL
Subdivision Name
L+M Pequot MRI Services
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070007H
Medicare Provider Number
070007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/11/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/12/2016
Last Recertification Date
11/15/2017
Termination Date
Termination Reason
2/28/2018
Change of hospital entity type
Contacts
Authorizing Official
Yale New Haven Health System
Douglas Payne, Director, Reimbursement Yale New Haven Health System
(203) 688-4878
Primary Contact
Yale New Haven Health System
Mary G Messina, Director, Regulatory Reimbursement YNHHS
(203) 688-8543
Addresses
Street Address
52 Hazelnut Hill Road
Groton, CT 06340
Billing Address
Lawrence & Memorial Hospital
365 Montauk Ave
New London, CT 06320
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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