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DSH220086DM 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 - Prophylactic MAB Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH220086DM
Medicare Provider Number
220086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2023
Participating Start Date
1/1/2024
Participating Approval Date
11/9/2023
Last Recertification Date
Termination Date
Termination Reason
7/1/2024
Site closure
Contacts
Authorizing Official
BIDMC
Matthew Larkin, Chief Operating Officer
(617) 677-7144
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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