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DSH220071M MASSACHUSETTS GENERAL HOSPITAL (Terminated)
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Main Details
Name
MASSACHUSETTS GENERAL HOSPITAL
Subdivision Name
THE GENERAL HOSPITAL CORPORATION / GI Lab
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220071M
Medicare Provider Number
220071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/28/2017
Last Recertification Date
11/3/2017
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Mass General Hospital
Sally Mason Boemer, Senior Vice President of Finance
(617) 724-4537
Primary Contact
Massachusetts General Hospital
Christopher Fortier, Chief Pharmacy Officer
(617) 726-2513
Addresses
Street Address
32 FRUIT STREET
YAWKEY CENTER FOR OUTPATIENT CARE
BOSTON, MA 02114-2620
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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