340B Drug Pricing Program Database


DSH390142 ALBERT EINSTEIN MEDICAL CENTER (Active) - information as of 5/11/2025 11:36:29 PM

Main Details
ALBERT EINSTEIN MEDICAL CENTER
Disproportionate Share Hospital
No
DSH390142
390142


Additional Details
Active
6/5/2006
1/1/2005
6/5/2006
8/26/2024

Contacts

Jefferson Health
Walter Wyatt, VP-Finance
(215) 254-3254

Jefferson Health
Dustin Ottemiller, VP, Finance
(215) 503-5219

Addresses

5501 OLD YORK ROAD
PHILADELPHIA, PA 19141

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
6/5/2006 - REPLACES DSH1914112/22/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
NJ41948021104989474,1174522114,1518000686,1881798320,1891010229,1902805245
NY003824211104989474,1174522114,1518000686,1881798320,1891010229,1902805245
DE2000194211104989474,1174522114,1518000686,1881798320,1891010229,1902805245
PA1007544140124,1007544140015,1007544140081,1007544140069,1007544140099,1007544140133,1007544140114,1007544140115,1007544140118,10075441400961104989474,1174522114,1518000686,1881798320,1891010229,1902805245
Shipping Addresses

EINSTEIN APOTHECARY
5501 OLD YORK ROAD
LEVY BUILDING, 1ST FLOOR
PHILADELPHIA, PA 19141

Einstein at Center One Pharmacy
9880 Bustleton Ave
Suite 305
Philadelphia, PA 19115

Jefferson Distributor
3500 Horizon Drive
Room 1074
King of Prussia, PA 19406
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/12/201707/01/2017  07/15/2024
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884910/12/202210/25/2022  10/25/2022
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/15/202410/01/2024  10/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/12/201707/01/2017 07/31/202307/15/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/12/201707/01/2017  07/15/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/15/202410/01/2024  10/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/15/202410/01/2024  10/01/2024
Contract DetailACRO PHARMACEUTICAL SERVICES LLCACRO PHARMACEUTICAL SERVICES LLC 313 HENDERSON DR
SHARON HILLPA1907907/16/201810/01/2018 06/22/201906/24/2019
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771301/09/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267001/09/202404/01/2024  04/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526101/09/202404/01/2024  04/01/2024
Contract DetailBRIOVARX OF MAINE INCDBA BRIOVARX 53 DARLING AVE
SOUTH PORTLANDME0410607/06/201710/01/2017 10/01/201910/01/2019
Contract DetailBRIOVARX OF MASSACHUSETTS, LLCD/B/A BRIOVARX BLDG 2 - UNIT A
145 BODWELL STREET 		AVONMA0232207/06/201710/01/2017 10/01/201910/01/2019
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/06/201707/01/2017  04/20/2017
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/06/201707/01/2017  04/20/2017
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/15/202507/01/2025  04/15/2025
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/06/201707/01/2017  04/20/2017
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/15/202507/01/2025  04/15/2025
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/15/202507/01/2025  04/15/2025
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/15/202507/01/2025  04/15/2025
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/15/202507/01/2025  04/15/2025
Contract DetailCOMMCARE PHARMACY-FTL, LLC855 SW 78TH AVE STE C100
PLANTATIONFL33324-322307/16/201810/01/2018 06/22/201906/24/2019
Contract DetailCOORDINATED CARE NETWORKCOORDINATED CARE NETWORK 300 PENN CENTER BLVD STE 405
PITTSBURGHPA15235-551106/01/201006/01/2010  04/20/2017
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/15/202105/03/2021  05/03/2021
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/15/202105/03/2021  05/03/2021
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/15/202507/01/2025  04/15/2025
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/13/202104/01/2021  04/01/2021
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268304/15/202105/03/2021 06/01/202206/03/2022
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654101/09/202404/01/2024  04/01/2024
Contract DetailECKERD CORPORATIONRITE AID #11136 1334 WINDRIM AVENUE
PHILADELPHIAPA1914107/03/201410/01/2014 07/31/201504/20/2017
Contract DetailECKERD CORPORATIONRITE AID #11136 1334 WINDRIM AVENUE
PHILADELPHIAPA1914110/15/202001/01/2021  01/01/2021
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/14/202108/09/2021  08/09/2021
Contract DetailK & K RX SERVICES, LPBIOMATRIX SPECIALTY PHARMACY PA 3070 MCCANN FARM DR STE 101
GARNET VALLEYPA1906004/10/201507/01/2015  04/20/2017
Contract DetailOPTUM FRONTIER THERAPIES II, LLC6425 SANTA MARGARITA ST UNIT 110
LAS VEGASNV89118-191307/06/201710/01/2017 10/23/202012/03/2020
Contract DetailOPTUM INFUSION SERVICES 204, INC8509 BENJAMIN RD STE A
TAMPAFL33634-122404/15/202105/03/2021  07/15/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC15529 COLLEGE BLVD.
LENEXAKS66219-135104/15/202105/03/2021  07/15/2024
Contract DetailOPTUM INFUSION SERVICES 305, LLC4000 CHEMICAL RD STE 100
PLYMOUTH MEETINGPA1946204/15/202105/03/2021  07/15/2024
Contract DetailOPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/15/202105/03/2021  07/15/2024
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276507/15/202410/01/2024  10/01/2024
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/12/202204/14/2022  07/15/2024
Contract DetailOPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520407/15/202410/01/2024  10/01/2024
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713007/06/201710/01/2017  07/15/2024
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729807/06/201710/01/2017 04/01/202104/15/2021
Contract DetailOPTUM PHARMACY 705, LLC1893 GENERAL GEORGE PATTON DR STE 106
FRANKLINTN37067-265504/15/202105/03/2021  07/15/2024
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729810/12/202301/01/2024  07/15/2024
Contract DetailOPTUM PHARMACY 706, INC.30-30 47TH AVENUE SUITE 410
LONG ISLAND CITYNY1110107/06/201710/01/2017  07/15/2024
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/15/202105/03/2021  07/15/2024
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983807/20/202310/01/2023  07/15/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02074 4133 G ST.
PHILADELPHIAPA1912404/15/202105/03/2021  05/03/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02156 5843-45 RISING SUN AVENUE
PHILADELPHIAPA1912004/15/202105/03/2021 11/07/202305/02/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02120 6344 STENTON AVENUE
PHILADELPHIAPA1913804/15/202105/03/2021  05/03/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02255 2640 E. CUMBERLAND ST.
PHILADELPHIAPA1912504/15/202105/03/2021  05/03/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00771 6150 N 5TH STREET
PHILADELPHIAPA1912004/15/202105/03/2021  05/03/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01196 7700 GERMANTOWN AVENUE
PHILADELPHIAPA1911804/15/202105/03/2021  05/03/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00371 6501 HARBISON AVENUE
PHILADELPHIAPA1914904/15/202105/03/2021  05/03/2021
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02113 1600 WADSWORTH AVENUE
PHILADELPHIAPA1915004/12/202204/14/2022  04/14/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00660 9875 BUSTLETON AVENUE
PHILADELPHIAPA1911504/12/202204/14/2022  04/14/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 03011 1799 DEKALB PIKE
BLUE BELLPA1942204/12/202204/14/2022  04/14/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02121 6601 NORTH BROAD STREET
PHILADELPHIAPA1912604/12/202204/14/2022  04/14/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02397 8525 FRANKFORD AVENUE
PHILADELPHIAPA1913601/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00780 1301 RHAWN ST.
PHILADELPHIAPA1911101/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00791 920 BETHLEHEM PIKE
ERDENHEIMPA1903801/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00740 10901C BUSTLETON AVENUE
PHILADELPHIAPA1911601/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00919 2622 JENKINTOWN ROAD
GLENSIDEPA1903801/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 07184 7720 BUSTLETON AVE
PHILADELPHIAPA1915201/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 17555 2450 SHOPPERS LN
WYNCOTEPA1909501/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 08984 6701 RIDGE AVE.
PHILADELPHIAPA1912801/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01193 835 OLD YORK ROAD
JENKINTOWNPA1904601/13/202301/30/2023  01/30/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02530 2870 MORELAND ROAD
WILLOW GROVEPA1909001/13/202301/30/2023  01/30/2023
Contract DetailPERFORMSPECIALTY, LLC2416 LAKE ORANGE DR. STE 190
ORLANDOFL3283710/12/202210/25/2022  10/25/2022
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999201/13/202104/01/2021 10/01/202211/03/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/06/201707/01/2017  04/20/2017
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY # 02553 1117 WALNUT ST.
PHILADELPHIAPA1910704/10/202007/01/2020  07/01/2020
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255001/09/202404/01/2024  04/01/2024
Contract DetailRITE AID DRUG PALACE, INC.RITE AID #553 4011 COTTMAN AVENUE
PHILADELPHIAPA1913501/14/202201/25/2022 09/27/202305/02/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3461 5301 CHEW AVENUE
PHILADELPHIAPA1913807/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2604 6101 NORTH BROAD STREET
PHILADELPHIAPA1914107/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #872 164 WEST CHELTEN AVENUE
PHILADELPHIAPA1914407/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1941 7401 OGONTZ AVENUE
PHILADELPHIAPA1913807/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #552 6401 OXFORD AVENUE
PHILADELPHIAPA1911107/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3688 4616-4650 NORTH BROAD STREET
PHILADELPHIAPA1914007/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #478 5400 RISING SUN AVENUE
PHILADELPHIAPA1912007/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #225 5612 N. FIFTH STREET
PHILADELPHIAPA1912007/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1563 6201 GERMANTOWN AVENUE
PHILADELPHIAPA1914407/03/201410/01/2014 07/31/201504/20/2017
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #478 5400 RISING SUN AVENUE
PHILADELPHIAPA1912010/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #554 9280 KREWSTOWN ROAD
PHILADELPHIAPA1911510/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #552 6401 OXFORD AVENUE
PHILADELPHIAPA1911110/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2604 6101 NORTH BROAD STREET
PHILADELPHIAPA1914110/15/202001/01/2021 11/20/202305/02/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #225 5612 N. FIFTH STREET
PHILADELPHIAPA1912010/15/202001/01/2021 10/23/202305/02/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1941 7401 OGONTZ AVENUE
PHILADELPHIAPA1913810/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1299 2503-05 WELSH ROAD
PHILADELPHIAPA1911410/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3461 5301 CHEW AVENUE
PHILADELPHIAPA1913810/15/202001/01/2021 09/05/202305/02/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #821 6744-46 NORTH FIFTH STREET
PHILADELPHIAPA1912610/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2797 1401 WEST CHELTENHAM AVENUE
MELROSE PARKPA1902710/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #872 164 WEST CHELTEN AVENUE
PHILADELPHIAPA1914410/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3688 4616-4650 NORTH BROAD STREET
PHILADELPHIAPA1914010/15/202001/01/2021 05/31/202307/20/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1563 6201 GERMANTOWN AVENUE
PHILADELPHIAPA1914410/15/202001/01/2021  01/01/2021
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1288 1315 EAST WASHINGTON LANE
PHILADELPHIAPA1913807/14/202108/09/2021 11/16/202305/02/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2587 3260 NORTH BROAD STREET
PHILADELPHIAPA1914001/14/202201/25/2022  01/25/2022
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1016 8130 ROOSEVELT BOULEVARD
PHILADELPHIAPA1915201/14/202201/25/2022 09/05/202305/02/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3637 6363 FRANKFORD AVENUE
PHILADELPHIAPA1913501/10/202301/30/2023  01/30/2023
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2709 8235 STENTON AVENUE
PHILADELPHIAPA1915001/10/202301/30/2023 09/26/202305/02/2024
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500201/09/202404/01/2024  04/01/2024
Contract DetailRXD MEDICATION SERVICES1335 W TABOR RD
PHILADELPHIAPA1914101/10/202301/30/2023  01/30/2023
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301301/09/202404/01/2024  04/01/2024
Contract DetailTHRIFT DRUG, INC.RITE AID #11139 6515 CASTOR AVENUE
PHILADELPHIAPA1914901/10/202301/30/2023  01/30/2023
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738604/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-2068180 LEVITTOWN PARKWAY
LEVITTOWNPA1905504/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-26504301 BYBERRY RD, UNIT A
PHILADELPHIAPA1915404/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-3475650 SOUTH TROOPER ROAD
NORRISTOWNPA1940304/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-35642101 BLAIR MILL RD
WILLOW GROVEPA1909004/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-51034600 E ROOSEVELT BLVD BLDG G
PHILADELPHIAPA1912407/08/201410/01/2014 07/31/201504/20/2017
Contract DetailWAL-MART PHARMACY 10-51034600 E ROOSEVELT BLVD BLDG G
PHILADELPHIAPA1912404/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-51309745 ROOSEVELT BLVD A
PHILADELPHIA (BU)PA1911404/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-52291000 EASTON RD STE 200
WYNCOTEPA1909504/10/202007/01/2020  07/01/2020
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283704/10/202007/01/2020  07/01/2020
Contract DetailWALGREEN EASTERN CO INCDBA: WALGREENS # 04115 4201 N BROAD ST
PHILADELPHIAPA1914001/13/202104/01/2021 01/30/202503/31/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #12097 1 ROBERT WOOD JOHNSON PL.
NEW BRUNSWICKNJ08901-192805/07/201205/07/2012 07/31/201504/20/2017
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 03569 4001 KENSINGTON AVE.
PHILADELPHIAPA1912401/13/202104/01/2021 04/01/202104/15/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 05522 1607 BRIDGE ST
PHILADELPHIAPA1912401/13/202104/01/2021 11/15/202311/20/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06894 2727 W CHELTENHAM AVENUE
WYNCOTEPA1909501/13/202104/01/2021  04/01/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 7201 CASTOR AVE.
PHILADELPHIAPA1914901/13/202104/01/2021 01/23/202503/31/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 06367 1809 E ALLEGHENY AVE
PHILADELPHIAPA1913401/13/202104/01/2021 03/02/202303/09/2023
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 01255 12050 BUSTLETON AVENUE
PHILADELPHIAPA1911601/13/202104/01/2021 04/01/202104/15/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07225 1 YORKTOWN PLAZA
ELKINS PARKPA1902701/13/202104/01/2021  04/01/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS 112 W CHELTEN AVE
PHILADELPHIAPA1914401/13/202104/01/2021  04/01/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 07544 10000 BUSTLETON AVE
PHILADELPHIAPA19116-374801/13/202104/01/2021  04/01/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS # 04926 7001 FRANKFORD AVE
PHILADELPHIAPA1913501/13/202104/01/2021  04/01/2021
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #12097 1 ROBERT WOOD JOHNSON PL.
NEW BRUNSWICKNJ08901-192804/12/202204/14/2022  04/14/2022
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #15316 1227 LOCUST ST
PHILADELPHIAPA1910704/13/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #11595 245 N BROAD ST STE 1
PHILADELPHIAPA1910704/13/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21251 3550 MARKET ST STE 103
PHILADELPHIAPA1910404/13/202407/01/2024  07/01/2024
Contract DetailWALGREEN EASTERN CO., INC.DBA WALGREENS SPECIALTY PHARMACY #21169 541 HAMILTON ST
ALLENTOWNPA1810107/15/202410/01/2024  10/01/2024
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/13/202104/01/2021  04/01/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/13/202104/01/2021 10/01/202110/06/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/13/202104/01/2021  04/01/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/13/202104/01/2021  04/01/2021
Contract DetailWALNUT HOME THERAPEUTICS3500 HORIZON DRIVE
KING OF PRUSSIAPA1940610/13/202110/25/2021  10/25/2021
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH390142AChildDSHALBERT EINSTEIN MEDICAL CENTERALBERT EINSTEIN CANCER CENTER @ CENTER ONE9880 Bustleton AvenuePhiladelphiaPAActive
DSH390142AAChildDSHALBERT EINSTEIN MEDICAL CENTERObservation MA5B - Observation60 Township Line RoadElkins ParkPATerminated
DSH390142ABChildDSHALBERT EINSTEIN MEDICAL CENTERObservation MA2C - Observation60 Township Line RoadElkins ParkPATerminated
DSH390142ACChildDSHALBERT EINSTEIN MEDICAL CENTERCenter For Wound Healing - Wound Healing1200 West Tabor RoadPhiladelphiaPAActive
DSH390142ADChildDSHALBERT EINSTEIN MEDICAL CENTERRheumatology Outpatient - Rheumatology Outpatient5401 Old York RoadPhiladelphiaPAActive
DSH390142AEChildDSHALBERT EINSTEIN MEDICAL CENTEROutpatient Gastroenterology - Outpatient Gastroenterology5401 Old York RoadPhiladelphiaPAActive
DSH390142AFChildDSHALBERT EINSTEIN MEDICAL CENTERAlbert Einstein Medical Center-Neurology - Neurology5401 Old York RoadPhiladelphiaPAActive
DSH390142AGChildDSHALBERT EINSTEIN MEDICAL CENTERAlbert Einstein Medical Center-Pulmonary - Pulmonary5401 Old York RoadPhiladelphiaPAActive
DSH390142AHChildDSHALBERT EINSTEIN MEDICAL CENTEREndocrinology - EP - Endocrinology50 East Township Line RoadElkins ParkPAActive
DSH390142BChildDSHALBERT EINSTEIN MEDICAL CENTERPSYCH EMERGENCY GERMANTOWNONE PENN BOULEVARDPHILADELPHIAPATerminated
DSH390142DChildDSHALBERT EINSTEIN MEDICAL CENTERAMBULATORY SURGERY CENTER ONE9880 Bustleton AvenuePhiladelphiaPAActive
DSH390142EChildDSHALBERT EINSTEIN MEDICAL CENTERANESTHESIOLOGY ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142FChildDSHALBERT EINSTEIN MEDICAL CENTERECHO/STRESS LAB ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142GChildDSHALBERT EINSTEIN MEDICAL CENTEREMERGENCY DEPARTMENT ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142HChildDSHALBERT EINSTEIN MEDICAL CENTERGAIT ANALYSIS LAB ELKINS PARK60 Township Line RoadElkins ParkPAActive
DSH390142JChildDSHALBERT EINSTEIN MEDICAL CENTERMOTOR CONTROL LAB ELKINS PARK60 Township Line RoadElkins ParkPAActive
DSH390142KChildDSHALBERT EINSTEIN MEDICAL CENTEROPERATING ROOM ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142LChildDSHALBERT EINSTEIN MEDICAL CENTERRADIOLOGY CENTER ONE9880 Bustleton AvenuePhiladelphiaPAActive
DSH390142MChildDSHALBERT EINSTEIN MEDICAL CENTERRADIOLOGY CT SCAN ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142NChildDSHALBERT EINSTEIN MEDICAL CENTERRADIOLOGY DIAGNOSTIC ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142PChildDSHALBERT EINSTEIN MEDICAL CENTERRADIOLOGY MRI ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142QChildDSHALBERT EINSTEIN MEDICAL CENTERRECOVERY ROOM ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142RChildDSHALBERT EINSTEIN MEDICAL CENTERRESPIRATORY THERAPY/EKG ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142SChildDSHALBERT EINSTEIN MEDICAL CENTERSHORT PROCEDURE UNIT ELKINS PARK60 TOWNSHIP LINE ROADELKINS PARKPATerminated
DSH390142TChildDSHALBERT EINSTEIN MEDICAL CENTERCenter One-EMG/Diagnostics9880 Bustleton AvenuePhiladelphiaPAActive
DSH390142UChildDSHALBERT EINSTEIN MEDICAL CENTERAnesthesia Pain Center1200 W Tabor RoadPhiladelphiaPAActive
DSH390142VChildDSHALBERT EINSTEIN MEDICAL CENTERHepatology/Liver5401 Old York RoadPhiladelphiaPAActive
DSH390142WChildDSHALBERT EINSTEIN MEDICAL CENTERKidney Acquisition/Transplant5401 Old York RoadPhiladelphiaPAActive
DSH390142XChildDSHALBERT EINSTEIN MEDICAL CENTERGastroenterology Procedures1200 West Tabor RoadPhiladelphiaPAActive
DSH390142YChildDSHALBERT EINSTEIN MEDICAL CENTERObservation MA2P - Observation60 Township Line RoadElkins ParkPATerminated
DSH390142ZChildDSHALBERT EINSTEIN MEDICAL CENTERObservation MA5A - Observation60 Township Line RoadElkins ParkPATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateProfile Change RequestWyatt, Walter VP-Finance Albert Einstein Medical Center 2152543254Wyatt, Walter VP-Finance Jefferson Health 21525432541/30/2025 1:33 PM
ContactsPrimary ContactUpdateProfile Change RequestOttemiller, Dustin VP, Finance Thomas Jefferson University Hospitals, Inc. 2155035219Ottemiller, Dustin VP, Finance Jefferson Health 21550352199/3/2024 11:17 AM
DetailsLast Recertification DateUpdateRecertification8/23/2023 12:00:49 PM8/26/2024 12:22:20 PM8/26/2024 12:22 PM
AddressesShipping AddressInsertChange Request Jefferson Distributor 3500 Horizon Drive Room 1074 King of Prussia, PA 194068/5/2024 1:57 PM
ContactsPrimary ContactUpdateChange RequestHauser, Deborah Director, Outpatient Pharmacy Albert Einstein Medical Center 2154566486Ottemiller, Dustin VP, Finance Thomas Jefferson University Hospitals, Inc. 21550352195/3/2024 3:23 PM
AddressesShipping AddressDeleteRecertificationEinstein at Center One Pharmacy 9880 Bustleton Ave Suite 332 Philadelphia, PA 19115 8/23/2023 12:00 PM
AddressesShipping AddressInsertRecertification Einstein at Center One Pharmacy 9880 Bustleton Ave Suite 305 Philadelphia, PA 191158/23/2023 12:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/23/2023 12:00 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10075441401148/23/2023 12:00 PM
Medicaid BillingMedicaid: StateInsertRecertification PA8/23/2023 12:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/23/2023 12:00 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10075441401158/23/2023 12:00 PM
Medicaid BillingMedicaid: StateInsertRecertification PA8/23/2023 12:00 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/23/2023 12:00 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10075441401188/23/2023 12:00 PM
Medicaid BillingMedicaid: StateInsertRecertification PA8/23/2023 12:00 PM
DetailsLast Recertification DateUpdateRecertification9/1/2022 3:10:29 PM8/23/2023 12:00:49 PM8/23/2023 12:00 PM
ContactsPrimary ContactUpdateChange RequestHauser, Deborah Director, Pharmacy Services Einstein Healthcare Network 2154566486Hauser, Deborah Director, Outpatient Pharmacy Albert Einstein Medical Center 215456648611/17/2022 2:53 PM
ContactsAuthorizing OfficialUpdateChange RequestWyatt, Walter VP, Finance Albert Einstein Medical Center 2152543254Wyatt, Walter VP-Finance Albert Einstein Medical Center 215254325411/17/2022 2:53 PM
DetailsLast Recertification DateUpdateRecertification8/30/2021 11:18:10 AM9/1/2022 3:10:29 PM9/1/2022 3:10 PM
ContactsAuthorizing OfficialUpdateChange RequestBLANEY, GERARD CHIEF FINANCIAL OFFICER Einstein Healthcare Network 2154566020Wyatt, Walter VP, Finance Albert Einstein Medical Center 21525432546/13/2022 6:53 AM
DetailsLast Recertification DateUpdateRecertification8/27/2020 2:38:52 PM8/30/2021 11:18:10 AM8/30/2021 11:18 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False8/6/2021 3:21 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10075441401338/6/2021 3:21 PM
Medicaid BillingMedicaid: StateInsertChange Request PA8/6/2021 3:21 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/27/2020 2:38 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10075441401248/27/2020 2:38 PM
Medicaid BillingMedicaid: StateInsertRecertification PA8/27/2020 2:38 PM
Medicaid BillingNPI: NumberDeleteRecertification1902805245 ( ) 8/27/2020 2:38 PM
Medicaid BillingNPI: NumberDeleteRecertification1104989474 ( ) 8/27/2020 2:38 PM
Medicaid BillingNPI: NumberDeleteRecertification1881798320 ( ) 8/27/2020 2:38 PM
Medicaid BillingNPI: NumberDeleteRecertification1174522114 ( ) 8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11049894748/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NY8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11745221148/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NY8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 15180006868/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NY8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18817983208/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NY8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18910102298/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NY8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 19028052458/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NY8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11049894748/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11745221148/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 15180006868/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18817983208/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18910102298/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 19028052458/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11049894748/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification DE8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11745221148/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification DE8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 15180006868/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification DE8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18817983208/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification DE8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18910102298/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification DE8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 19028052458/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification DE8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11049894748/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NJ8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 11745221148/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NJ8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 15180006868/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NJ8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18817983208/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NJ8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 18910102298/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NJ8/27/2020 2:38 PM
Medicaid BillingNPI: NumberInsertRecertification 19028052458/27/2020 2:38 PM
Medicaid BillingNPI: StateInsertRecertification NJ8/27/2020 2:38 PM
Medicaid BillingNPI: NumberDeleteRecertification1518000686 ( ) 8/27/2020 2:38 PM
Medicaid BillingNPI: NumberDeleteRecertification1891010229 ( ) 8/27/2020 2:38 PM
DetailsLast Recertification DateUpdateRecertification8/29/2019 8:10:20 AM8/27/2020 2:38:52 PM8/27/2020 2:38 PM
DetailsLast Recertification DateUpdateRecertification8/30/2018 10:35:56 AM8/29/2019 8:10:20 AM8/29/2019 8:10 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/4/2019 3:38 PM
Medicaid BillingMedicaid: NumberInsertChange Request 41948024/4/2019 3:38 PM
Medicaid BillingMedicaid: StateInsertChange Request NJ4/4/2019 3:38 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/4/2019 3:38 PM
Medicaid BillingMedicaid: NumberInsertChange Request 003824214/4/2019 3:38 PM
Medicaid BillingMedicaid: StateInsertChange Request NY4/4/2019 3:38 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False4/4/2019 3:38 PM
Medicaid BillingMedicaid: NumberInsertChange Request 2000194214/4/2019 3:38 PM
Medicaid BillingMedicaid: StateInsertChange Request DE4/4/2019 3:38 PM
DetailsLast Recertification DateUpdateRecertification11/17/2017 10:00:13 AM8/30/2018 10:35:56 AM8/30/2018 10:35 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestBLANEY, GERARD VICE PRESIDENT FINANCE Einstein Healthcare Network 2154566020BLANEY, GERARD CHIEF FINANCIAL OFFICER Einstein Healthcare Network 21545660208/30/2018 10:19 AM
AddressesShipping AddressInsertChange Request Einstein at Center One Pharmacy 9880 Bustleton Ave Suite 332 Philadelphia, PA 191155/2/2018 5:09 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False11/17/2017 10:00 AM
Medicaid BillingMedicaid: NumberInsertRecertification 100754414009611/17/2017 10:00 AM
Medicaid BillingMedicaid: StateInsertRecertification PA11/17/2017 10:00 AM
Medicaid BillingNPI: NumberInsertRecertification 189101022911/17/2017 10:00 AM
DetailsLast Recertification DateUpdateRecertification8/12/2016 12:00:00 AM11/17/2017 10:00:13 AM11/17/2017 10:00 AM
ContactsAuthorizing OfficialUpdate BLANEY, GERARD VICE PRESIDENT FINANCE 2154566020BLANEY, GERARD VICE PRESIDENT FINANCE Einstein Healthcare Network 215456602010/20/2017 12:58 PM
ContactsPrimary ContactUpdate Hauser, Deborah Director, Pharmacy Services 2154566486Hauser, Deborah Director, Pharmacy Services Einstein Healthcare Network 215456648610/9/2017 3:20 PM
ContactsPrimary ContactInsert  Hauser, Deborah Director, Pharmacy Services 21545664867/25/2017 8:40 AM
ContactsAuthorizing OfficialInsert  BLANEY, GERARD VICE PRESIDENT FINANCE 21545660207/25/2017 8:40 AM
AddressesMain AddressInsert   5501 OLD YORK ROAD PHILADELPHIA, PA 191414/20/2017 5:41 PM
AddressesShipping AddressInsert  EINSTEIN APOTHECARY 5501 OLD YORK ROAD LEVY BUILDING, 1ST FLOOR PHILADELPHIA, PA 191414/20/2017 5:41 PM
DetailsLast Recertification DateUpdate 8/14/2015 12:00:00 AM8/12/2016 12:00:00 AM8/12/2016 2:29 PM
Medicaid BillingMedicaid: Is PrimaryUpdate TrueFalse8/14/2015 9:50 AM
DetailsLast Recertification DateUpdate 8/19/2014 12:00:00 AM8/14/2015 12:00:00 AM8/14/2015 9:50 AM
DetailsLast Recertification DateUpdate 8/29/2013 12:00:00 AM8/19/2014 12:00:00 AM8/19/2014 11:46 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/23/2014 7:55 PM
Medicaid BillingMedicaid: NumberInsert  10075441400153/23/2014 7:55 PM
Medicaid BillingMedicaid: StateInsert  PA3/23/2014 7:55 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/23/2014 7:55 PM
Medicaid BillingMedicaid: NumberInsert  10075441400813/23/2014 7:55 PM
Medicaid BillingMedicaid: StateInsert  PA3/23/2014 7:55 PM
Medicaid BillingMedicaid: Is PrimaryInsert  False3/23/2014 7:55 PM
Medicaid BillingMedicaid: NumberInsert  10075441400693/23/2014 7:55 PM
Medicaid BillingMedicaid: StateInsert  PA3/23/2014 7:55 PM
Medicaid BillingNPI: NumberInsert  19028052453/23/2014 7:55 PM
Medicaid BillingNPI: NumberInsert  11049894743/23/2014 7:55 PM
Medicaid BillingNPI: NumberInsert  18817983203/23/2014 7:55 PM
Medicaid BillingNPI: NumberInsert  11745221143/23/2014 7:55 PM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/29/2013 12:00:00 AM8/29/2013 9:42 AM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/18/2012 12:30 PM
Medicaid BillingMedicaid: NumberUpdate 100754414001510075441400993/26/2012 9:45 AM
Medicaid BillingNPI: NumberInsert  15180006863/26/2012 9:45 AM
DetailsLast Recertification DateInsert   12/22/2010 12:25 PM
DetailsGrant NumberInsert   12/22/2010 12:25 PM
Details340B IDInsert  DSH39014212/22/2010 12:25 PM
DetailsIs Authorizing Official EHB DataInsert   12/22/2010 12:25 PM
DatesLast Date That 340B Drugs PurchasedInsert   12/22/2010 12:25 PM
DetailsMedicare Provider NumberInsert  39014212/22/2010 12:25 PM
DetailsEntity NameInsert  ALBERT EINSTEIN MEDICAL CENTER12/22/2010 12:25 PM
DetailsProgram CodeInsert  DSH12/22/2010 12:25 PM
DetailsEntity SubnameInsert   12/22/2010 12:25 PM
DatesParticipating Approval DateInsert  6/5/2006 12:00:00 AM12/22/2010 12:25 PM
DetailsStateInsert  Active12/22/2010 12:25 PM
DatesRegistration DateInsert  6/5/2006 12:00:00 AM12/22/2010 12:25 PM
DatesSigned By DateInsert   12/22/2010 12:25 PM
DatesStart DateInsert  1/1/2005 12:00:00 AM12/22/2010 12:25 PM
TerminationsTermination CommentsInsert   12/22/2010 12:25 PM
TerminationsTermination DateInsert   12/22/2010 12:25 PM
TerminationsTermination Effective DateInsert   12/22/2010 12:25 PM
TerminationsTermination ReasonInsert   12/22/2010 12:25 PM
DetailsComments PublicInsert  6/5/2006 - REPLACES DSH1914112/22/2010 12:25 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True6/5/2006 8:08 AM
Medicaid BillingMedicaid: NumberInsert  10075441400156/5/2006 8:08 AM
Medicaid BillingMedicaid: StateInsert  PA6/5/2006 8:08 AM