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DSH070010BF BRIDGEPORT HOSPITAL (Terminated)
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Main Details
Name
BRIDGEPORT HOSPITAL
Subdivision Name
PAMC PREOP - PREOPERATIVE SURGICAL SERVICES
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH070010BF
Medicare Provider Number
070010
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2020
Participating Start Date
7/1/2020
Participating Approval Date
6/2/2020
Last Recertification Date
Termination Date
Termination Reason
10/1/2020
Other
Contacts
Authorizing Official
Bridgeport Hospital
PATRICK MCCABE, SENIOR VP FINANCE/CFO
(203) 688-2345
Primary Contact
Yale New Haven Health System
Mary G Messina, Director, Regulatory Reimbursement YNHHS
(203) 688-8543
Addresses
Street Address
5520 Park Avenue
Trumbull, CT 06611
Billing Address
BRIDGEPORT HOSPITAL
267 GRANT STREET
BRIDGEPORT, CT 06510
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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