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DSH470011G Brattleboro Memorial Hospital (Terminated)
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Main Details
Name
Brattleboro Memorial Hospital
Subdivision Name
JUST SO PEDIATRICS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH470011G
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
8/22/2019
Termination Date
Termination Reason
10/1/2020
Site closure
Contacts
Authorizing Official
Brattleboro Memorial Hospital
Michael Rogers, Vice President, Finance
(802) 257-8279
Primary Contact
Brattleboro Memorial Hospital
Deanna Auger, Certified Pharmacy Technician
(802) 257-8267
Addresses
Street Address
19 BELMONT AVE 102
BRATTLEBORO, VT 05301-4004
Billing Address
Brattleboro Memorial Hospital
17 Belmont Avenue
Brattleboro, VT 05301
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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