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DSH300012 ELLIOT HOSPITAL (Terminated)
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Main Details
Name
ELLIOT HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH300012
Medicare Provider Number
300012
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2021
Participating Start Date
3/12/2021
Participating Approval Date
2/8/2021
Last Recertification Date
9/14/2022
Termination Date
Termination Reason
1/1/2023
DSH percentage below statutory minimum
Contacts
Authorizing Official
Elliot Hospital
Joseph Tate Curti, COO
(603) 663-2082
Primary Contact
Elliot Hospital
Michelle Marie Andrade, 340B Program Manager
(603) 663-2430
Addresses
Street Address
1 ELLIOT WAY
MANCHESTER, NH 03103
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (7/1/2018), until terminated effective date: (1/1/2020), reinstatement effective date: (04/01/2021)
02/08/2021
April 2025
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