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DSH220071AM MASSACHUSETTS GENERAL HOSPITAL (Active)
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Main Details
Name
MASSACHUSETTS GENERAL HOSPITAL
Subdivision Name
THE GENERAL HOSPITAL CORPORATION / MGH Revere - Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220071AM
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
385 BROADWAY
MGH REVERE BROADWAY HEALTH CENTER
REVERE, MA 02151-3033
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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