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DSH470011M Brattleboro Memorial Hospital (Terminated)
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Main Details
Name
Brattleboro Memorial Hospital
Subdivision Name
FOUR SEASONS OBGYN & MIDWIFERY - Obstetrics and Gynecology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH470011M
Medicare Provider Number
470011
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2023
Participating Start Date
7/1/2023
Participating Approval Date
5/9/2023
Last Recertification Date
8/23/2023
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Brattleboro Memorial Hospital
Jennifer Griffey, Chief Financial Officer
(802) 257-8716
Primary Contact
Brattleboro Memorial Hospital
Shelly Gonthier, 340B Program Coordinator
(802) 257-8267
Addresses
Street Address
29 Ridgewood Road
Suite C
Springfield, VT 05156
Billing Address
Brattleboro Memorial Hospital
17 Belmont Ave
Brattleboro, VT 05301
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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