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DSH220086CB BETH ISRAEL DEACONESS MEDICAL CENTER (Terminated)
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Main Details
Name
BETH ISRAEL DEACONESS MEDICAL CENTER
Subdivision Name
Beth Israel Deaconess Medical Center - ANESTHESIA
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220086CB
Medicare Provider Number
220086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/2/2020
Participating Start Date
4/1/2020
Participating Approval Date
2/11/2020
Last Recertification Date
9/5/2020
Termination Date
Termination Reason
4/1/2021
Other
Contacts
Authorizing Official
Beth Israel Deaconess Medical Center
Michael Cullen, CFO
(617) 667-7146
Primary Contact
Beth Israel Lahey Health
Shawn J Wood, Director of System 340B Oversight
(781) 352-6685
Addresses
Street Address
1 Deaconess Rd
Boston, MA 02215
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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