340B Drug Pricing Program Database
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DSH070010AK BRIDGEPORT HOSPITAL (Terminated)
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Main Details
Name
BRIDGEPORT HOSPITAL
Subdivision Name
0309BH OUTPATIENT IMAGING PARK AVE IR - IMAGING SERVICES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070010AK
Medicare Provider Number
070010
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/25/2018
Last Recertification Date
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Bridgeport Hospital
PATRICK MCCABE, SENIOR VP FINANCE/CFO
(203) 688-2345
Primary Contact
Yale New Haven Health System
Mary G Messina, Director, Regulatory Reimbursement YNHHS
(203) 688-8543
Addresses
Street Address
5520 Park Avenue
Trumbull, CT 06611
Billing Address
Bridgeport Hospital
267 Grant Street
Bridgeport, CT 06610
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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