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RRC220110-55 BRIGHAM AND WOMENS HOSPITAL (Active)
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Main Details
Name
BRIGHAM AND WOMENS HOSPITAL
Subdivision Name
BWH 850 PC AT FISH CENTER BWH WHC INTMED 850
Type
Rural Referral Center
Rural
Yes
340B ID
RRC220110-55
Medicare Provider Number
220110
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/4/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/10/2018
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Brigham and Women's Hospital - Boston, MA
Garrett McKinnon, Vice President of Finance
(857) 282-4406
Primary Contact
Massachusetts General Hospital
Rafic Nehme, Director, Pharmacy Business & Finance
(617) 726-5125
Addresses
Street Address
850 Boylston St
Suite 402
Chestnut Hill, MA 02467
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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