Covered Entity Details

DSH390226AM THE PENNSYLVANIA HOSPITAL (Active) - information as of 6/21/2025 10:40:26 PM

Main Details

Name

THE PENNSYLVANIA HOSPITAL

Subdivision Name

Surgical Oncology PMWS - Surgery

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390226AM

Medicare Provider Number

390226

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/10/2024

Participating Start Date

7/1/2024

Participating Approval Date

4/23/2024

Last Recertification Date

8/20/2024

Contacts

Authorizing Official

Pennsylvania Hospital
Lindsay Ayling, CFO
(215) 713-4943

Primary Contact

Pennsylvania Hospital
Glen Bianchini, Director of Pharmacy Services
(215) 829-5847

Addresses

Street Address

800 Walnut Street
8th Floor
Philadelphia, PA 19107

Billing Address

Pennsylvania Hospital
800 Spruce Street
Philadelphia, PA 19107

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
PA	1000049150036,100004915,1000049150005,1000049150007,1000049150009,1000049150013,1000049150030,1000049150031,1000049150032,1000049150034,1000049150039,1000049150041,1000049150042,1000049150035,1000049150043,1000049150044	1063489342,1023153053,1306814348,1184692121,1659349694,1851440606,1336304062,1407909088,1477808459,1649323932

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH390226A	Child	DSH	THE PENNSYLVANIA HOSPITAL		800 SPRUCE STREET	PHILADELPHIA	PA	Terminated
DSH390226AA	Child	DSH	THE PENNSYLVANIA HOSPITAL	334391 PULMONARY PAH-MAPS	800 Walnut St., 9th Fl.	Philadelphia	PA	Active
DSH390226AB	Child	DSH	THE PENNSYLVANIA HOSPITAL	334341 PMWS AUDIOLOGY MAPS	800 Walnut St., 18th Fl.	Philadelphia	PA	Active
DSH390226AC	Child	DSH	THE PENNSYLVANIA HOSPITAL	334333 PAH ORTHOPEDICS-MAPS	800 Spruce St., 1st Fl Cathcart	Philadelphia	PA	Active
DSH390226AD	Child	DSH	THE PENNSYLVANIA HOSPITAL	334335 Rehab Med - Rehabilitation	801 Spruce Street	Philadelphia	PA	Terminated
DSH390226AE	Child	DSH	THE PENNSYLVANIA HOSPITAL	334339 Neurosurgery - Neurosurgery	801 Spruce St	Philadelphia	PA	Active
DSH390226AF	Child	DSH	THE PENNSYLVANIA HOSPITAL	334396 GI Farm Journal - GI	230 West Washington Square	Philadelphia	PA	Active
DSH390226AG	Child	DSH	THE PENNSYLVANIA HOSPITAL	DERMATOLOGY CLINIC - Derm PAH/Derm General PAH/Derm Path PAH	235 S 8TH ST	PHILADELPHIA	PA	Active
DSH390226AH	Child	DSH	THE PENNSYLVANIA HOSPITAL	Plastic Surgery PMWS - Surgery	800 Walnut Street	Philadelphia	PA	Active
DSH390226AJ	Child	DSH	THE PENNSYLVANIA HOSPITAL	PULMONARY ALS - MEDICINE/NEUROLOGY	330 S. 9th Street	Philadelphia	PA	Active
DSH390226AK	Child	DSH	THE PENNSYLVANIA HOSPITAL	Radiation Oncology PMWS - Rad Onc	800 Walnut Street	Philadelphia	PA	Active
DSH390226AL	Child	DSH	THE PENNSYLVANIA HOSPITAL	SPINE CENTER - ORTHOPAEDICS - ORTHOPAEDICS	801 Spruce Street	Philadelphia	PA	Active
DSH390226AM	Child	DSH	THE PENNSYLVANIA HOSPITAL	Surgical Oncology PMWS - Surgery	800 Walnut Street	Philadelphia	PA	Active
DSH390226AN	Child	DSH	THE PENNSYLVANIA HOSPITAL	Spine Center PMR PAH - Rehabilitation	801 Spruce Street	Philadelphia	PA	Active
DSH390226AP	Child	DSH	THE PENNSYLVANIA HOSPITAL	Cardiac Rehab - Cardiology	700 Spruce Street	Philadelphia	PA	Active
DSH390226AQ	Child	DSH	THE PENNSYLVANIA HOSPITAL	Diabetes Education - Diabetes Educattion	700 Spruce Street	Philadelphia	PA	Active
DSH390226AR	Child	DSH	THE PENNSYLVANIA HOSPITAL	SLEEP MEDICINE PMWS - MEDICINE	800 Walnut Street	Phiadelphia	PA	Active
DSH390226AS	Child	DSH	THE PENNSYLVANIA HOSPITAL	GI Womens First Center PMWS - GI	800 Walnut Street	Philadelphia	PA	Active
DSH390226AT	Child	DSH	THE PENNSYLVANIA HOSPITAL	Speech PMWS - Oto-Speech	800 Walnut Street	Philadelphia	PA	Active
DSH390226AU	Child	DSH	THE PENNSYLVANIA HOSPITAL	Spine Center Pain PAH - Pain	801 Spruce Street	Philadelphia	PA	Active
DSH390226AV	Child	DSH	THE PENNSYLVANIA HOSPITAL	UROGYN WOMENS FIRST CENTER PMWS - OB/GYN	800 Walnut St	Philadelphia	PA	Active
DSH390226AW	Child	DSH	THE PENNSYLVANIA HOSPITAL	Vascular Surgery Clinic - Vascular Clinic	700 Spruce Street	Philadelphia	PA	Approved
DSH390226AX	Child	DSH	THE PENNSYLVANIA HOSPITAL	Vascular Surgery Lab - Vascular Lab	700 Spruce Street	Philadelphia	PA	Approved
DSH390226AY	Child	DSH	THE PENNSYLVANIA HOSPITAL	SPRUCE MRI - Radiology	801 SPRUCE ST	PHILADELPHIA	PA	Approved
DSH390226B	Child	DSH	THE PENNSYLVANIA HOSPITAL	334322 PAH-OUTPATIENT-OR-WEST	1840 South St.	Philadelphia	PA	Active
DSH390226C	Child	DSH	THE PENNSYLVANIA HOSPITAL	335632 RADIOLOGY - SERVICES WEST	1840 South St.	Philadelphia	PA	Active
DSH390226D	Child	DSH	THE PENNSYLVANIA HOSPITAL	334330 PAH PAIN CLINIC-MAPS	1840 South St.	Philadelphia	PA	Active
DSH390226E	Child	DSH	THE PENNSYLVANIA HOSPITAL	334332 PAH NEUROLOGY-MAPS	330 S. 9th St.	Philadelphia	PA	Active
DSH390226F	Child	DSH	THE PENNSYLVANIA HOSPITAL	PAH SURGERY-MAPS	800 Walnut St.	Philadelphia	PA	Active
DSH390226G	Child	DSH	THE PENNSYLVANIA HOSPITAL	334339 PAH NEUROSURGERY-MAPS	235 S. 8th St.	Philadelphia	PA	Terminated
DSH390226H	Child	DSH	THE PENNSYLVANIA HOSPITAL	334340 PAH OBGYN MFM-MAPS	800 Walnut St.	Philadelphia	PA	Active
DSH390226J	Child	DSH	THE PENNSYLVANIA HOSPITAL	334342 PAH OBGYN GYN-MAPS	800 Walnut St.	Philadelphia	PA	Active
DSH390226K	Child	DSH	THE PENNSYLVANIA HOSPITAL	334344 PAH OBGYN GYN ONC-MAPS	800 Walnut St.	Philadelphia	PA	Active
DSH390226L	Child	DSH	THE PENNSYLVANIA HOSPITAL	334346 PAH OBGYN SS-MAPS	800 Walnut St.	Philadelphia	PA	Terminated
DSH390226M	Child	DSH	THE PENNSYLVANIA HOSPITAL	334348 PAH OBGYN REI-MAPS	800 Walnut St.	Philadelphia	PA	Active
DSH390226N	Child	DSH	THE PENNSYLVANIA HOSPITAL	Spine Center (Short Procedure Unit)	801 Spruce St.	Philadelphia	PA	Active
DSH390226P	Child	DSH	THE PENNSYLVANIA HOSPITAL	335548 CMH - Emer & Eval Svc	801 Spruce St.	Philadelphia	PA	Active
DSH390226Q	Child	DSH	THE PENNSYLVANIA HOSPITAL	335630 Gamma Knife	801 Spruce St.	Philadelphia	PA	Active
DSH390226R	Child	DSH	THE PENNSYLVANIA HOSPITAL	335549 CMH - OPS AD SOC CLINIC	245 S. 8th St.	Philadelphia	PA	Active
DSH390226S	Child	DSH	THE PENNSYLVANIA HOSPITAL	334153335027 PAH - Infusion Center	Abramson Cancer Ctr at PA Hosp Infusion	PHILADELPHIA	PA	Active
DSH390226T	Child	DSH	THE PENNSYLVANIA HOSPITAL	THE PENNSYLVANIA HOSPITAL OF THE UN / 334334 PAH OTO-MAPS	800 WALNUT ST 18	PHILADELPHIA	PA	Active
DSH390226U	Child	DSH	THE PENNSYLVANIA HOSPITAL	THE PENNSYLVANIA HOSPITAL OF THE UN	230W WASHINGTON SQ 3	PHILADELPHIA	PA	Active
DSH390226V	Child	DSH	THE PENNSYLVANIA HOSPITAL	PAH UROLOGY-MAPS / 334338 PAH UROLOGY-MAPS	800 Walnut St. 19	Philadelphia	PA	Active
DSH390226W	Child	DSH	THE PENNSYLVANIA HOSPITAL	Pulmonary Lab	800 WALNUT ST 9	PHILADELPHIA	PA	Active
DSH390226X	Child	DSH	THE PENNSYLVANIA HOSPITAL	PAH Penn Medicine Washington Square MAPS	800 Walnut St., 9th Fl.	Philadelphia	PA	Active
DSH390226Y	Child	DSH	THE PENNSYLVANIA HOSPITAL	334347 PAH UROGYN	800 Walnut St., 10th Fl.	Philadelphia	PA	Active
DSH390226Z	Child	DSH	THE PENNSYLVANIA HOSPITAL	334345 Obstetrics – Pennsylvania Hospital-Washington Square	800 Walnut St., 10th Fl.	Philadelphia	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Recertification	1000049150008 (PA)		8/20/2024 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1000049150035	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1000049150043	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1000049150044	8/20/2024 1:53 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/20/2024 1:53 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1407909088	8/20/2024 1:53 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/20/2024 1:53 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1477808459	8/20/2024 1:53 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/20/2024 1:53 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1649323932	8/20/2024 1:53 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/20/2024 1:53 PM
Details	Last Recertification Date	Update	Recertification		8/20/2024 1:53:55 PM	8/20/2024 1:53 PM
Details	State	Update		Approved	Active	7/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Ayling, Lindsay CFO Pennsylvania Hospital 2157134943	4/23/2024 8:24 AM
Details	340B ID	Update	New Registration		DSH390226AM	4/23/2024 8:24 AM
Details	Entity Name	Update	New Registration	PENNSYLVANIA HOSPITAL OF UPHS	THE PENNSYLVANIA HOSPITAL	4/23/2024 8:24 AM
Details	Entity Subname	Update	New Registration	Surgical Oncology PMWS	Surgical Oncology PMWS - Surgery	4/23/2024 8:24 AM
Dates	Participating Approval Date	Update	New Registration		4/23/2024 8:24:09 AM	4/23/2024 8:24 AM
Details	State	Update	New Registration	Pending	Approved	4/23/2024 8:24 AM
Dates	Signed By Date	Update	New Registration		4/10/2024 12:59:02 PM	4/23/2024 8:24 AM
Dates	Start Date	Update	New Registration		7/1/2024 12:00:00 AM	4/23/2024 8:24 AM
Addresses	Main Address	Insert	New Registration		800 Walnut Street 8th Floor Philadelphia, PA 19107	4/10/2024 12:20 PM
Addresses	Billing Address	Insert	New Registration		Pennsylvania Hospital 800 Spruce Street Philadelphia, PA 19107	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150036	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150008	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100004915	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150005	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150007	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150009	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150013	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150030	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150031	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150032	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150034	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150039	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150041	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150042	4/10/2024 12:20 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1063489342	4/10/2024 12:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1023153053	4/10/2024 12:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306814348	4/10/2024 12:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1184692121	4/10/2024 12:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1659349694	4/10/2024 12:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1851440606	4/10/2024 12:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1336304062	4/10/2024 12:20 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/10/2024 12:20 PM
Contacts	Authorizing Official	Insert	New Registration		Ayling, Lindsay CFO Pennsylvania Hospital 2157134943	4/10/2024 12:20 PM
Contacts	Primary Contact	Insert	New Registration		Bianchini, Glen Director of Pharmacy Services Pennsylvania Hospital 2158295847	4/10/2024 12:20 PM
Details	Assistance Received From Date	Insert	New Registration			4/10/2024 12:20 PM
Details	Assistance Received To Date	Insert	New Registration			4/10/2024 12:20 PM
Details	Last Recertification Date	Insert	New Registration			4/10/2024 12:20 PM
Details	Grant Number	Insert	New Registration			4/10/2024 12:20 PM
Details	340B ID	Insert	New Registration			4/10/2024 12:20 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/10/2024 12:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/10/2024 12:20 PM
Details	Medicare Provider Number	Insert	New Registration		390226	4/10/2024 12:20 PM
Details	Entity Name	Insert	New Registration		PENNSYLVANIA HOSPITAL OF UPHS	4/10/2024 12:20 PM
Details	NOFO Number	Insert	New Registration			4/10/2024 12:20 PM
Details	Program Code	Insert	New Registration		DSH	4/10/2024 12:20 PM
Details	Entity Subname	Insert	New Registration		Surgical Oncology PMWS	4/10/2024 12:20 PM
Dates	Participating Approval Date	Insert	New Registration			4/10/2024 12:20 PM
Details	State	Insert	New Registration		Pending	4/10/2024 12:20 PM
Dates	Registration Date	Insert	New Registration		4/10/2024 12:20:06 PM	4/10/2024 12:20 PM
Dates	Signed By Date	Insert	New Registration			4/10/2024 12:20 PM
Dates	Start Date	Insert	New Registration			4/10/2024 12:20 PM
Terminations	Termination Comments	Insert	New Registration			4/10/2024 12:20 PM
Terminations	Termination Date	Insert	New Registration			4/10/2024 12:20 PM
Terminations	Termination Effective Date	Insert	New Registration			4/10/2024 12:20 PM
Terminations	Termination Reason	Insert	New Registration			4/10/2024 12:20 PM