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DSH470011F Brattleboro Memorial Hospital (Terminated)
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Main Details
Name
Brattleboro Memorial Hospital
Subdivision Name
FOUR SEASONS OBGYN AND MIDWIFERY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH470011F
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
9/12/2022
Termination Date
Termination Reason
4/1/2023
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Brattleboro Memorial Hospital
Jennifer Griffey, Chief Financial Officer
(802) 257-8716
Primary Contact
Brattleboro Memorial Hospital
Shelly Gonthier, 340B Program Coordinator
(802) 257-8267
Addresses
Street Address
17 Belmont Ave
Ron Reed Pavilion
2401
BRATTLEBORO, VT 05301
Billing Address
Brattleboro Memorial Hospital
17 Belmont Avenue
Brattleboro, VT 05301
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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