Covered Entity Details

DSH390226AX THE PENNSYLVANIA HOSPITAL (Approved) - information as of 6/6/2025 4:29:49 AM

Main Details

Name

THE PENNSYLVANIA HOSPITAL

Subdivision Name

Vascular Surgery Lab - Vascular Lab

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390226AX

Medicare Provider Number

390226

Outpatient Facility Provider Number

Additional Details

Current Program Status

Approved

Registration Date

4/4/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/2/2025

Last Recertification Date

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

700 Spruce Street
Suite 101
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	100004915,1000049150005,1000049150007,1000049150009,1000049150013,1000049150030,1000049150031,1000049150032,1000049150034,1000049150035,1000049150036,1000049150039,1000049150041,1000049150042,1000049150043,1000049150044	1023153053,1063489342,1184692121,1306814348,1336304062,1407909088,1477808459,1649323932,1659349694,1851440606

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
Contacts	Signed By	Insert	New Registration		Ayling, Lindsay CFO Pennsylvania Hospital 2157134943	5/2/2025 11:12 AM
Details	340B ID	Update	New Registration		DSH390226AX	5/2/2025 11:12 AM
Details	Entity Name	Update	New Registration	PENNSYLVANIA HOSPITAL OF UPHS	THE PENNSYLVANIA HOSPITAL	5/2/2025 11:12 AM
Details	Entity Subname	Update	New Registration	Vascular Surgery Lab	Vascular Surgery Lab - Vascular Lab	5/2/2025 11:12 AM
Dates	Participating Approval Date	Update	New Registration		5/2/2025 11:12:01 AM	5/2/2025 11:12 AM
Details	State	Update	New Registration	Pending	Approved	5/2/2025 11:12 AM
Dates	Signed By Date	Update	New Registration		4/8/2025 2:06:31 PM	5/2/2025 11:12 AM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/2/2025 11:12 AM
Addresses	Main Address	Insert	New Registration		700 Spruce Street Suite 101 Philadelphia, PA 19107	4/4/2025 10:59 AM
Addresses	Billing Address	Insert	New Registration		Pennsylvania Hospital 800 Spruce Street Philadelphia, PA 19107	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100004915	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150005	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150007	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150009	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150013	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150030	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150031	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150032	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150034	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150035	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150036	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150039	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150041	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150042	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150043	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1000049150044	4/4/2025 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1023153053	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1063489342	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1184692121	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1306814348	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1336304062	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1407909088	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1477808459	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1649323932	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1659349694	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1851440606	4/4/2025 10:59 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/4/2025 10:59 AM
Contacts	Authorizing Official	Insert	New Registration		Ayling, Lindsay CFO Pennsylvania Hospital 2157134943	4/4/2025 10:59 AM
Contacts	Primary Contact	Insert	New Registration		Bianchini, Glen Director of Pharmacy Services Pennsylvania Hospital 2158295847	4/4/2025 10:59 AM
Details	Assistance Received From Date	Insert	New Registration			4/4/2025 10:59 AM
Details	Assistance Received To Date	Insert	New Registration			4/4/2025 10:59 AM
Details	Last Recertification Date	Insert	New Registration			4/4/2025 10:59 AM
Details	Grant Number	Insert	New Registration			4/4/2025 10:59 AM
Details	340B ID	Insert	New Registration			4/4/2025 10:59 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2025 10:59 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2025 10:59 AM
Details	Medicare Provider Number	Insert	New Registration		390226	4/4/2025 10:59 AM
Details	Entity Name	Insert	New Registration		PENNSYLVANIA HOSPITAL OF UPHS	4/4/2025 10:59 AM
Details	NOFO Number	Insert	New Registration			4/4/2025 10:59 AM
Details	Program Code	Insert	New Registration		DSH	4/4/2025 10:59 AM
Details	Entity Subname	Insert	New Registration		Vascular Surgery Lab	4/4/2025 10:59 AM
Dates	Participating Approval Date	Insert	New Registration			4/4/2025 10:59 AM
Details	State	Insert	New Registration		Pending	4/4/2025 10:59 AM
Dates	Registration Date	Insert	New Registration		4/4/2025 10:59:54 AM	4/4/2025 10:59 AM
Dates	Signed By Date	Insert	New Registration			4/4/2025 10:59 AM
Dates	Start Date	Insert	New Registration			4/4/2025 10:59 AM
Terminations	Termination Comments	Insert	New Registration			4/4/2025 10:59 AM
Terminations	Termination Date	Insert	New Registration			4/4/2025 10:59 AM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2025 10:59 AM
Terminations	Termination Reason	Insert	New Registration			4/4/2025 10:59 AM