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RRC220110-99 BRIGHAM AND WOMENS HOSPITAL (Terminated)
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Main Details
Name
BRIGHAM AND WOMENS HOSPITAL
Subdivision Name
HALE BUILDING - ALLERGY CLINIC AT 850 Infusion Therapy
Type
Rural Referral Center
Rural
Yes
340B ID
RRC220110-99
Medicare Provider Number
220110
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/12/2019
Last Recertification Date
Termination Date
Termination Reason
7/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Brigham and Women’s Hospital
Christopher Dunleavy, Chief Financial Officer
(617) 732-7899
Primary Contact
Brigham and Women’s Hospital
John Fanikos, Executive Director of Pharmacy Services
(617) 732-7165
Addresses
Street Address
60 Fenwood Rd.
Boston, MA 02115
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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