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DSH220033BH BEVERLY HOSPITAL (Terminated)
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Main Details
Name
BEVERLY HOSPITAL
Subdivision Name
ADDISON GILBERT HOSPITAL - UROLOGY - UROLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220033BH
Medicare Provider Number
220033
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
9/15/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Beverly Hospital
Gregory Beaumier, CFO - Beverly Hospital
(978) 816-2587
Primary Contact
Beth Israel Lahey Health
Shawn J Wood, Director of System 340B Oversight
(781) 352-6685
Addresses
Street Address
298 Washington Street
Fourth Floor
Gloucester, MA 01930
Billing Address
Beverly Hospital
85 Herrick Street
Beverly, MA 01915
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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