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DSH220071AT MASSACHUSETTS GENERAL HOSPITAL (Active)
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Main Details
Name
MASSACHUSETTS GENERAL HOSPITAL
Subdivision Name
MGH Back Bay Primary Health Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220071AT
Medicare Provider Number
220071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/16/2021
Participating Start Date
3/24/2021
Participating Approval Date
3/17/2021
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Mass General Hospital
Sally Mason Boemer, Senior Vice President of Finance
(617) 724-4537
Primary Contact
Massachusetts General Hospital
Rafic Nehme, Director, Pharmacy Business & Finance
(617) 726-5125
Addresses
Street Address
388 COMMONWEALTH AVENUE
BOSTON, MA 02115-2800
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 7/1/2017, terminated 1/1/2020. Reinstated 4/1/2021.
03/17/2021
April 2025
April 2025
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