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DSH470011A Brattleboro Memorial Hospital (Terminated)
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Main Details
Name
Brattleboro Memorial Hospital
Subdivision Name
BMH UROLOGY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH470011A
Medicare Provider Number
470011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/18/2016
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
10/1/2024
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Brattleboro Memorial Hospital
Laura Bruno, Interium Chief Financial Officer
(802) 257-8385
Primary Contact
Brattleboro Memorial Hospital
Shelly Gonthier, 340B Program Coordinator
(802) 257-8267
Addresses
Street Address
28 Belmont Ave
BRATTLEBORO, VT 05301-6936
Billing Address
Brattleboro Memorial Hospital
17 Belmont Avenue
Brattleboro, VT 05301
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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