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DSH070007W LAWRENCE & MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
LAWRENCE & MEMORIAL HOSPITAL
Subdivision Name
LMH VASCULAR SURGERY LIMB PRESERVATION - VASCULAR LIMB SERVICE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070007W
Medicare Provider Number
070007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2019
Participating Start Date
10/1/2019
Participating Approval Date
7/24/2019
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Yale New Haven Health System
Mary G Messina, Director, Regulatory Reimbursement YNHHS
(203) 688-8543
Primary Contact
Yale New Haven Health System
Maria Da Silva, Senior Reimbursement Analyst
(203) 688-9332
Addresses
Street Address
52 HAZELNUT HILL ROAD
GROTON, CT 06340-3268
Billing Address
LAWRENCE & MEMORIAL HOSPITAL
365 MONTAUK AVENUE
NEW LONDON, CT 06320-4700
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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