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DSH410007AZ RHODE ISLAND HOSPITAL (Terminated)
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Main Details
Name
RHODE ISLAND HOSPITAL
Subdivision Name
EEG Neuro Laboratory
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH410007AZ
Medicare Provider Number
410007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2022
Participating Start Date
10/1/2022
Participating Approval Date
8/23/2022
Last Recertification Date
8/21/2024
Termination Date
Termination Reason
1/1/2025
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Brown University Health
Michael D Dawson, VP Finance
(401) 444-2648
Primary Contact
Brown University Health
CHRISTINE COLLINS, SVP, Pharmacy & Periop, Chief Pharmacy Officer
(401) 444-4434
Addresses
Street Address
1407 South County Trail
Suite 430 B
East Greenwich, RI 02816
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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