340B Drug Pricing Program Database
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DSH220033AT BEVERLY HOSPITAL (Terminated)
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Main Details
Name
BEVERLY HOSPITAL
Subdivision Name
ADDISON GILBERT HOSPITAL / AGH LAB PHLEBOTOMY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220033AT
Medicare Provider Number
220033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/24/2017
Last Recertification Date
Termination Date
Termination Reason
1/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Northeast Hospital Corporation
Connie Woodworth, Vice President Finance
(978) 922-3000 Ext: 2587
Primary Contact
220033
Hope Violette, Director of Pharmacy
(978) 922-3000 Ext: 2612
Addresses
Street Address
298 Washington Street
Gloucester, MA 01930
Billing Address
Beverly Hospital
85 Herrick Street
Gloucester, MA 01915
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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