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DSH220086BH BETH ISRAEL DEACONESS MEDICAL CENTER (Terminated)
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Main Details
Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
LOWRY MEDICAL OFFICE - OTOLARYNGOLOGY CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220086BH
Medicare Provider Number
220086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/23/2018
Last Recertification Date
9/6/2019
Termination Date
Termination Reason
10/1/2020
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Beth Israel Deaconess Medical Center
Michael Cullen, CFO
(617) 667-7146
Primary Contact
Beth Israel Deaconess Medical Center
Shawn Wood, Pharmacy 340B and Inventory Supervisor
(617) 754-3835
Addresses
Street Address
110 FRANCIS STREET
BOSTON, MA 02215
Billing Address
Beth Israel Deaconess Medical Center
One Deaconess Road
Boston, MA 02215
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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