Covered Entity Details

DSH390027A TEMPLE UNIVERSITY HOSPITAL (Active) - information as of 6/16/2025 1:04:39 AM

Main Details

Name

TEMPLE UNIVERSITY HOSPITAL

Subdivision Name

TUHE-Emergency Dept

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390027A

Medicare Provider Number

390027

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

5/31/2006

Participating Start Date

7/1/2006

Participating Approval Date

6/1/2006

Last Recertification Date

8/17/2024

Contacts

Authorizing Official

Temple University Hospital
Abhinav Rastogi, President & C.E.O
(215) 707-4299

Primary Contact

Temple University Hospital
Deborah Hauser, VP - CHIEF PHARMACY OFFICER
(215) 416-1682

Addresses

Street Address

100 East Lehigh
PHILADELPHIA, PA 19125-0000

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
10/29/10 UPDATED ADDR(WAS 100 E LEHIGH AVENUE)	05/31/2006

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	1007351140008,1007351140006,1007351140007,1007351140029,1007736990015	1295902518,1962579029,1942364781,1598858946,1275682148,1356981443,1275157455,1295278786,1316603947,1023884822

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
Contract Detail	PHILADELPHIA PHARMACY	101 E LEHIGH AVENUE		PHILADELPHIA	PA	19125	01/16/2014	04/01/2014		01/10/2018	01/12/2018

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH390027A	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE-Emergency Dept	100 East Lehigh	PHILADELPHIA	PA	Active
DSH390027AA	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE - Radiology Nuclear Med - Radioisotope	100 E Lehigh Ave	Philadelphia	PA	Active
DSH390027AB	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN - Radiology - CAT Scan - CT Scan	2301 E Allegheny Avenue	Philadelphia	PA	Active
DSH390027AC	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE - Wound Care - Hyperbaric Oxygen Chamber	100 E Lehigh Ave	Philadelphia	PA	Active
DSH390027AD	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN - Radiology - MRI - MRI	2301 E Allegheny Avenue	Philadelphia	PA	Active
DSH390027AE	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN - Endocopy - Short Procedure Unit	2301 E Allegheny Avenue	Philadelphia	PA	Active
DSH390027AF	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Operating Room - Operating Room	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AG	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ- EEG & Sleep Center - ELECTROENCEPHALOGRAPHY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AH	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Cardiovascular Cath - Cardiovascular Cath	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AJ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Gastroenterology - GASTROINTESTINAL SERVICES	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AK	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Anesthesiology - ANESTHESIOLOGY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AL	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Lab - Lab	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AM	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Speech Therapy - SPEECH PATHOLOGY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AN	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Vascular Lab - VASCULAR LAB	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AP	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Occupational Therapy - OCCUPATIONAL THERAPY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AQ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-PACU - RECOVERY ROOM	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AR	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Pain Management - ANESTHESIOLOGY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AS	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Radiology - Radiology	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AT	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Radiology-Ultrasound - Radiology	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AU	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Radiology-Nuclear Med - RADIOISOTOPE	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AV	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Emergency Dept - EMERGENCY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AW	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Respiratory Care - RESPIRATORY THERAPY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AX	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Cardiac Rehab/EMG/Heart Station - ELECTROCARDIOLOGY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AY	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Radiology-MRI - MRI	7600 Central Avenue	Philadelphia	PA	Active
DSH390027AZ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-IV Therapy-Nursing - INTRAVENOUS THERAPY	7600 Central Avenue	Philadelphia	PA	Terminated
DSH390027B	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN Infusion Center	2301 EAST ALLEGHENY AVENUE	PHILADELPHIA	PA	Active
DSH390027BA	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Surg Sht Proc Unit - OPERATING ROOM	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BB	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Radiology-Cat Scan - CT SCAN	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BC	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Physical Therapy - PHYSICAL THERAPY	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BD	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Bariatric - TUHJ-Bariatric	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BE	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Hemodialysis Unit - TUHJ-Hemodialysis Unit	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BF	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Clinic Cardiology	3509 N Broad Street	Philadelphia	PA	Active
DSH390027BG	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	FCCC-TUH Multispecialty Clinic & Infusion - FCCC-TUH Multispecialty Clinic & Infusion	333 Cottman Avenue	Philadelphia	PA	Active
DSH390027BH	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Clinic-Cardiology - TUHJ-Clinic-Cardiology	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BJ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Clinic-Endocrinology - TUHJ-Clinic-Endocrinology	7500 Central Ave	Philadelphia	PA	Active
DSH390027BK	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Clinic-Neurology - TUHJ-Clinic-Neurology	7500 Central Ave	Philadelphia	PA	Active
DSH390027BL	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Clinic-Rheumatology - TUHJ-Clinic-Rheumatology	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BM	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Clinic-Oncology - TUHJ-Clinic-Oncology	7600 Central Avenue	Philadelphia	PA	Terminated
DSH390027BN	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Clinic-Pulmonary - TUHJ-Clinic-Pulmonary	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BP	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN-Wound Care - TUHN-Wound Care	2301 E Allegheny Ave	Philadelphia	PA	Terminated
DSH390027BQ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE SHORT PROCEDURE UNIT - TUHE SHORT PROCEDURE UNIT	100 E. Lehigh Avenue	Philadelphia	PA	Terminated
DSH390027BT	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN-Heart Station - TUHN-Heart Station	2301 E Allegheny Ave	Philadelphia	PA	Active
DSH390027BU	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN-Chemotherapy - TUHN-Chemotherapy	2301 East Allegheny Care Center	Philadelphia	PA	Active
DSH390027BV	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Heart Station - TUHJ-Heart Station	7600 Central Avenue	Philadelphia	PA	Active
DSH390027BW	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Infusion Services FCCC-TUH - Infusion Services FCCC-TUH	333 Cottman Ave	Philadelphia	PA	Active
DSH390027BX	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUH-FC Clinics at E. Norriton - Oncology	2701 Dekalb Pike	East Norriton	PA	Active
DSH390027BY	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUH-FC Clinics at CHH - Oncology	8835 Germantown Ave	Philadelphia	PA	Active
DSH390027BZ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUH-FC Clinics at Buckingham - Oncology	2325 Heritage Circle	Buckingham	PA	Active
DSH390027C	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ BMT Outpatient	7600 Central Aveune	Philadelphia	PA	Active
DSH390027CA	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUH-FC Infusion at E. Norriton - Infusion	2701 Dekalb Pike	East Norriton	PA	Active
DSH390027CB	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUH-FC Infusion at CHH - Infusion	8835 Germantown Ave	Philadelphia	PA	Active
DSH390027CC	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUH-FC Infusion at Buckingham - Infusion	2325 Heritage Circle	Buckingham	PA	Active
DSH390027CD	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE-Addiction Medicine - Addiction	100 E. Lehigh Ave.	Philadelphia	PA	Active
DSH390027CE	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Radiology-Mammography - Mammography	7600 Central Avenue	Philadelphia	PA	Approved
DSH390027CF	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion-Radiology-Mammography - Mammography	3509 N Broad Street	Philadelphia	PA	Approved
DSH390027CG	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHW-Radiology-Mammography - Mammography	1331 East Wyoming Ave	Philadelphia	PA	Approved
DSH390027CH	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN-Radiology-Mammography - Mammography	2301 Allegheny Avenue	Philadelphia	PA	Approved
DSH390027CJ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion-Radiology-Nuclear Medicine - Nuclear Medicine	3509 N Broad Street	Philadelphia	PA	Approved
DSH390027CK	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Radiology-Special Proc - Special Procedures	7600 Central Avenue	Philadelphia	PA	Approved
DSH390027CL	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion-Radiology-MRI - MRI	3509 N Broad Street	Philadelphia	PA	Approved
DSH390027CM	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion-Radiology-Special Procedures - Special Procedures	3509 N Broad Street	Philadelphia	PA	Approved
DSH390027CN	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN-Radiology-Diag Imaging - Diagnostic Imaging	2301 Allegheny Avenue	Philadelphia	PA	Approved
DSH390027CP	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion-Radiology-Ultrasound - Ultrasound	3509 N Broad Street	Philadelphia	PA	Approved
DSH390027CQ	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHW-Radiology-Cat Scan - Cat Scan	1331 East Wyoming Ave	Philadelphia	PA	Approved
DSH390027CR	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE-Radiology-Ultrasound - Ultrasound	100 E Lehigh Ave	Philadelphia	PA	Approved
DSH390027CS	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN-Radiology-Ultrasound - Ultrasound	2301 Allegheny Avenue	Philadelphia	PA	Approved
DSH390027CT	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE-Radiology-Diag Imaging - Diagnostic Imaging	100 E Lehigh Ave	Philadelphia	PA	Approved
DSH390027CU	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Temple Sleep Center - Pulmonology	Oaks Medical Building	Phoenixville	PA	Approved
DSH390027CV	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion-Radiology-Cat Scan - Cat Scan	3509 N Broad Street	Philadelphia	PA	Approved
DSH390027CW	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHJ-Clinic-Gastroenterology - Gastroenterology	7600 Central Avenue	Philadelphia	PA	Approved
DSH390027CX	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHW-Radiology-MRI - MRI	1331 East Wyoming Ave	Philadelphia	PA	Approved
DSH390027D	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE / Psych Crisis Center	100 E Lehigh	Philadelphia	PA	Active
DSH390027E	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE-Industrial Health Center	100 E Lehigh	Philadelphia	PA	Terminated
DSH390027F	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE / Hemodialysis	100 E Lehigh	Philadelphia	PA	Terminated
DSH390027G	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE / EEG	100 E Lehigh	Philadelphia	PA	Terminated
DSH390027H	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE / Heart Station	100 E Lehigh	Philadelphia	PA	Active
DSH390027J	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE / Physical and Recreational Therapy	100 E Lehigh	Philadelphia	PA	Active
DSH390027K	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE / Respiratory Therapy	100 E Lehigh	Philadelphia	PA	Active
DSH390027L	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE / Radiology CT Scan	100 E Lehigh	Philadelphia	PA	Active
DSH390027M	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE Radiology - Mammography	100 E Lehigh	Philadelphia	PA	Active
DSH390027N	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHE- Clinic- Internal Med Amb	100 E Lehigh	Philadelphia	PA	Active
DSH390027P	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Physical Therapy	3509 N Broad Street	Philadelphia	PA	Active
DSH390027Q	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Radiology-Diagnostic Imaging	3509 N Broad Street	Philadelphia	PA	Active
DSH390027R	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Operating Room	3509 N Broad Street	Philadelphia	PA	Active
DSH390027S	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Neuromonitoring	3509 N Broad Street	Philadelphia	PA	Active
DSH390027T	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - PACU	3509 N Broad Street	Philadelphia	PA	Active
DSH390027U	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Vascular Lab	3509 N Broad Street	Philadelphia	PA	Active
DSH390027V	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Non-Invasive Lab	3509 N Broad Street	Philadelphia	PA	Active
DSH390027W	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Speech Therapy	3509 B Broad Street	Philadelphia	PA	Active
DSH390027X	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - Occupational Therapy	3509 N Broad Street	Philadelphia	PA	Active
DSH390027Y	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	Boyer Pavilion - CNPC-Clin Neuro Phy Ctr	3509 N Broad Street	Philadelphia	PA	Active
DSH390027Z	Child	DSH	TEMPLE UNIVERSITY HOSPITAL	TUHN - Radiology - Nuclear Med - Radioisotope	2301 E Allegheny Avenue	Philadelphia	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/17/2024 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007351140029	8/17/2024 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/17/2024 8:30 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/17/2024 8:30 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007736990015	8/17/2024 8:30 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/17/2024 8:30 AM
Details	Last Recertification Date	Update	Recertification	9/1/2023 10:47:18 AM	8/17/2024 8:30:08 AM	8/17/2024 8:30 AM
Contacts	Primary Contact	Update	Group Change Request	HORN, Jonathan Director, 340B Programs TEMPLE UNIVERSITY HOSPITAL 2674001466	Hauser, Deborah VP - CHIEF PHARMACY OFFICER Temple University Hospital 2154161682	8/6/2024 12:05 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1023884822	7/13/2024 12:50 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	7/13/2024 12:50 PM
Contacts	Primary Contact	Update	Group Change Request	Parekh, Shawn VP CPO Temple University Health System 2157074524	HORN, Jonathan Director, 340B Programs TEMPLE UNIVERSITY HOSPITAL 2674001466	4/29/2024 8:25 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2023 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007351140006	9/1/2023 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/1/2023 10:47 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/1/2023 10:47 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007351140007	9/1/2023 10:47 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/1/2023 10:47 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007351140003 (PA)		9/1/2023 10:47 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007351140013 (PA)		9/1/2023 10:47 AM
Details	Last Recertification Date	Update	Recertification	9/14/2022 1:51:18 PM	9/1/2023 10:47:18 AM	9/1/2023 10:47 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1295278786	12/28/2022 4:58 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	12/28/2022 4:58 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1316603947	12/28/2022 4:58 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	12/28/2022 4:58 PM
Contacts	Primary Contact	Update	Group Change Request	Moreau, Anaila AVP 340b/Ambulatory Pharmacy Services Temple University Hospital 2157074642	Parekh, Shawn VP CPO Temple University Health System 2157074524	12/12/2022 7:10 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1598858946	9/14/2022 1:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/14/2022 1:51 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275682148	9/14/2022 1:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/14/2022 1:51 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1356981443	9/14/2022 1:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/14/2022 1:51 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1275157455	9/14/2022 1:51 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/14/2022 1:51 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 11:39:30 AM	9/14/2022 1:51:18 PM	9/14/2022 1:51 PM
Details	Entity Subname	Update	Change Request	EPISCOPAL CAMPUS Emergency Services	TUHE-Emergency Dept	7/15/2022 12:35 PM
Contacts	Authorizing Official	Update	Change Request	Reed, Tony Chief Medical Officer Temple University Health System 2157075880	Rastogi, Abhinav President & C.E.O Temple University Hospital 2157074299	7/13/2022 8:06 AM
Addresses	Main Address	Update	Change Request	FRONT STREET AND LEHIGH AVE PHILADELPHIA, PA 19125-0000	100 East Lehigh PHILADELPHIA, PA 19125-0000	2/23/2022 12:49 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 3:22:35 PM	9/7/2021 11:39:30 AM	9/7/2021 11:39 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1962579029 ( )		9/9/2020 3:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1295902518	9/9/2020 3:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 3:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1962579029	9/9/2020 3:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 3:22 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1942364781	9/9/2020 3:22 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 3:22 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1295902518 ( )		9/9/2020 3:22 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1295902518 ( )		9/9/2020 3:22 PM
Details	Last Recertification Date	Update	Recertification	9/15/2019 9:58:26 AM	9/9/2020 3:22:35 PM	9/9/2020 3:22 PM
Contacts	Authorizing Official	Update	Change Request	white, herbert patrick Interim CFO Temple University Hospital 2157073802	Reed, Tony Chief Medical Officer Temple University Health System 2157075880	3/26/2020 4:43 PM
Contacts	Primary Contact	Update	Change Request	Robinson, Warren richard Director of Outpatient Pharmacy Services Temple University Health System 2157073181	Moreau, Anaila AVP 340b/Ambulatory Pharmacy Services Temple University Hospital 2157074642	3/24/2020 3:54 PM
Contacts	Primary Contact	Update	Change Request	Gerstien, Brad J. Manager of Pharmacy 340B Program and Enterprise Business Operations Temple University Hospital 2678581032	Robinson, Warren richard Director of Outpatient Pharmacy Services Temple University Health System 2157073181	1/31/2020 7:17 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 4:44:32 PM	9/15/2019 9:58:26 AM	9/15/2019 9:58 AM
Contacts	Authorizing Official	Update	AO Change Request	Oetzel, Gerald Chief Financial Officer Temple University Hospital 2157073743	white, herbert patrick Interim CFO Temple University Hospital 2157073802	3/25/2019 12:49 PM
Details	Last Recertification Date	Update	Recertification	12/1/2017 12:07:34 PM	8/20/2018 4:44:32 PM	8/20/2018 4:44 PM
Contacts	Authorizing Official	Update	AO Change Request	Lux, Robert H. Vice President, Chief Financial Officer & Treasurer Temple University Hospital 2157073802	Oetzel, Gerald Chief Financial Officer Temple University Hospital 2157073743	7/3/2018 7:40 AM
Details	Last Recertification Date	Update	Recertification	8/24/2016 12:00:00 AM	12/1/2017 12:07:34 PM	12/1/2017 12:07 PM
Contacts	Authorizing Official	Update		Lux, Robert H. Vice President, Chief Financial Officer & Treasurer 2157073802	Lux, Robert H. Vice President, Chief Financial Officer & Treasurer Temple University Hospital 2157073802	10/19/2017 5:08 PM
Contacts	Primary Contact	Update		Gerstien, Brad J. Manager of Pharmacy 340B Program and Enterprise Business Operations 2678581032	Gerstien, Brad J. Manager of Pharmacy 340B Program and Enterprise Business Operations Temple University Hospital 2678581032	9/20/2017 4:54 PM
Contacts	Authorizing Official	Update		CHABALOWSKI, EDWARD A. CFO 2157076798	Lux, Robert H. Vice President, Chief Financial Officer & Treasurer 2157073802	4/30/2017 9:16 PM
Contacts	Primary Contact	Update		KIM, EUN K. DIRECTOR OF PHARMACY SERVICES 2157070950	Gerstien, Brad J. Manager of Pharmacy 340B Program and Enterprise Business Operations 2678581032	2/14/2017 2:43 PM
Addresses	Main Address	Insert			FRONT STREET AND LEHIGH AVE PHILADELPHIA, PA 19125-0000	8/24/2016 12:29 PM
Details	Last Recertification Date	Update		9/2/2015 12:00:00 AM	8/24/2016 12:00:00 AM	8/24/2016 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/2/2015 8:41 AM
Medicaid Billing	Medicaid: Number	Insert			1007351140003	9/2/2015 8:41 AM
Medicaid Billing	Medicaid: State	Insert			PA	9/2/2015 8:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/2/2015 8:41 AM
Medicaid Billing	Medicaid: Number	Insert			1007351140013	9/2/2015 8:41 AM
Medicaid Billing	Medicaid: State	Insert			PA	9/2/2015 8:41 AM
Medicaid Billing	NPI: Number	Insert			1295902518	9/2/2015 8:41 AM
Medicaid Billing	NPI: Number	Insert			1295902518	9/2/2015 8:41 AM
Contacts	Primary Contact	Update		CHABALOWSKI, EDWARD A. CFO 2157076798	KIM, EUN K. DIRECTOR OF PHARMACY SERVICES 2157070950	9/2/2015 8:41 AM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	9/2/2015 12:00:00 AM	9/2/2015 8:41 AM
Details	Entity Subname	Update		EPISCOPAL CAMPUS	EPISCOPAL CAMPUS Emergency Services	1/23/2015 3:04 PM
Medicaid Billing	Medicaid: Number	Update		100-735-114	1007351140008	8/27/2014 10:57 AM
Medicaid Billing	NPI: Number	Insert			1962579029	8/27/2014 10:57 AM
Details	Last Recertification Date	Update		8/27/2013 12:00:00 AM	8/27/2014 12:00:00 AM	8/27/2014 10:57 AM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/27/2013 9:10 AM
Medicaid Billing	Medicaid: Number	Update		39-0027	100-735-114	8/27/2013 9:10 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/27/2013 12:00:00 AM	8/27/2013 9:10 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	4/30/2012 7:43 AM
Contacts	Authorizing Official	Insert			CHABALOWSKI, EDWARD A. CFO 2157076798	3/23/2012 2:30 PM
Contacts	Primary Contact	Insert			CHABALOWSKI, EDWARD A. CFO 2157076798	3/23/2012 2:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	5/31/2006 2:14 PM
Medicaid Billing	Medicaid: Number	Insert			39-0027	5/31/2006 2:14 PM
Medicaid Billing	Medicaid: State	Insert			PA	5/31/2006 2:14 PM
Details	Last Recertification Date	Insert				5/31/2006 2:14 PM
Details	Grant Number	Insert				5/31/2006 2:14 PM
Details	340B ID	Insert			DSH390027A	5/31/2006 2:14 PM
Details	Is Authorizing Official EHB Data	Insert				5/31/2006 2:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert				5/31/2006 2:14 PM
Details	Medicare Provider Number	Insert			390027	5/31/2006 2:14 PM
Details	Entity Name	Insert			TEMPLE UNIVERSITY HOSPITAL	5/31/2006 2:14 PM
Details	Program Code	Insert			DSH	5/31/2006 2:14 PM
Details	Entity Subname	Insert			EPISCOPAL CAMPUS	5/31/2006 2:14 PM
Dates	Participating Approval Date	Insert			6/1/2006 12:00:00 AM	5/31/2006 2:14 PM
Details	State	Insert			Active	5/31/2006 2:14 PM
Dates	Registration Date	Insert			5/31/2006 12:00:00 AM	5/31/2006 2:14 PM
Dates	Signed By Date	Insert			5/30/2006 12:00:00 AM	5/31/2006 2:14 PM
Dates	Start Date	Insert			7/1/2006 12:00:00 AM	5/31/2006 2:14 PM
Terminations	Termination Comments	Insert				5/31/2006 2:14 PM
Terminations	Termination Date	Insert				5/31/2006 2:14 PM
Terminations	Termination Effective Date	Insert				5/31/2006 2:14 PM
Terminations	Termination Reason	Insert				5/31/2006 2:14 PM
Details	Comments Public	Insert			10/29/10 UPDATED ADDR(WAS 100 E LEHIGH AVENUE)	5/31/2006 2:14 PM