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DSH070022CQ YALE NEW HAVEN HOSPITAL (Terminated)
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Main Details
Name
YALE NEW HAVEN HOSPITAL
Subdivision Name
Dermatology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070022CQ
Medicare Provider Number
070022
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2016
Participating Start Date
1/1/2017
Participating Approval Date
12/15/2016
Last Recertification Date
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Yale New Haven Hospital
Michael Loftus, Vice President - Finance
(203) 200-3833
Primary Contact
Yale New Haven Hospital
Lorraine Lee, Executive Director, System Pharmacy Services
(203) 688-6390
Addresses
Street Address
330 Orchard Street
New Haven, CT 06511
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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