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DSH220086BP BETH ISRAEL DEACONESS MEDICAL CENTER (Active)
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Main Details
Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
LOWRY MEDICAL OFFICE - LIVER CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220086BP
Medicare Provider Number
220086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/23/2018
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
BIDMC
Matthew Larkin, Chief Operating Officer
(617) 677-7144
Primary Contact
BILH
Jennifer Rossi, 340B Director of Compliance and Advocacy
(207) 266-9127
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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