340B Drug Pricing Program Database


DSH390256W PENN STATE - MILTON S. HERSHEY MEDICAL CENTER (Terminated) - information as of 6/2/2025 8:29:47 AM

Main Details
PENN STATE - MILTON S. HERSHEY MEDICAL CENTER
Cosmetic Surgery
Disproportionate Share Hospital
Yes
DSH390256W
390256


Additional Details
Terminated
7/11/2013
10/1/2013
9/13/2013
11/15/2017

10/1/2018
Change of covered entity type (non-hospital)

Contacts

Milton S. Hershey Medical Center
Eric Strucko, Interim Chief Financial Officer
(717) 531-6122

Penn State Hershey Medical Center
Vincent Lacroce, Administrative Director of Pharmacy
(717) 531-6378

Addresses

5 Capital Drive
STE 203
Harrisburg, PA 17110-9477

Penn State Milton S. Hershey Medical Center
500 University Dr
Hershey, PA 17033


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA1007653100027 
  1417094624
Shipping Addresses

Same as Street Address
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH390256AAChildDSHMILTON S. HERSHEY MEDICAL CENTERObstetrics & Gynecology - REPRODUCTIVE ENDOCRINOLOGY35 Hope DriveHersheyPAActive
DSH390256ABChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERPediatric Bone & Joint (Spina Bifida)30 Hope DriveHERSHEYPATerminated
DSH390256ACChildDSHMILTON S. HERSHEY MEDICAL CENTERTherapy Services (Speech Therapy)30 Hope DriveHersheyPAActive
DSH390256ADChildDSHMILTON S. HERSHEY MEDICAL CENTERTherapy Services (Occupational Therapy)30 Hope DriveHersheyPAActive
DSH390256AEChildDSHMILTON S. HERSHEY MEDICAL CENTERTherapy Services (Physical Therapy)30 Hope DriveHersheyPAActive
DSH390256AFChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Briarcrest (Diabetes & Weight)905 W. Governor RoadHersheyPAActive
DSH390256AGChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Briarcrest (Adolescent Medicine)905 W. Governor RoadHersheyPAActive
DSH390256AHChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Briarcrest (Pediatric Specialties)905 W. Governor RoadHersheyPAActive
DSH390256AJChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Mount Joy201 Lefever Rd.Mount JoyPAActive
DSH390256AKChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Psychiatry22 North East Dr.HERSHEYPAActive
DSH390256ALChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERPSHMG Camp Hill HVI / Heart and Vascular3025 Market St.Camp HillPATerminated
DSH390256AMChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERPSHMG Camp Hill / Echocardiogram3025 Market St.camp HillPATerminated
DSH390256ANChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERPSHMG Nyes Road II / Echocardiogram121 Nyes RoadHarrisburgPATerminated
DSH390256APChildDSHMILTON S. HERSHEY MEDICAL CENTERNeurophysiology30 Hope DriveHersheyPAActive
DSH390256AQChildDSHMILTON S. HERSHEY MEDICAL CENTERPlastic Surgery30 Hope DriveHersheyPAActive
DSH390256ARChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Palmyra HVI / Heart and Vascular941 Park Dr.PalmyraPAActive
DSH390256ASChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERBreast Imaging / Diagnostic Imaging30 Hope Dr.HersheyPATerminated
DSH390256ATChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERPenn State Hershey Medical Group Nyes Rd. / Diagnostic Imaging121 Nyes Rd.HarrisburgPATerminated
DSH390256AUChildDSHMILTON S. HERSHEY MEDICAL CENTER"PSHMG Mechanicsburg Family Medicine"140 Old Willow Mill RoadMechanicsburgPAActive
DSH390256AVChildDSHMILTON S. HERSHEY MEDICAL CENTERCocoaplex-Medicine - Multi Specialty1150 Cocoa AvenueHersheyPAActive
DSH390256AWChildDSHMILTON S. HERSHEY MEDICAL CENTERPediatric Specialties - Pediatric specialties200 Campus DriveHersheyPAActive
DSH390256AXChildDSHMILTON S. HERSHEY MEDICAL CENTERPain Medicine - Pain management UPC200 Campus DriveHersheyPAActive
DSH390256AYChildDSHMILTON S. HERSHEY MEDICAL CENTERRenal Dialysis (Hemodialysis) - Hemodialysis200 Campus DriveHersheyPAActive
DSH390256AZChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERSurgery Specialties (IBD Center) - Irritable bowel disease200 Campus DriveHersheyPATerminated
DSH390256BChildDSHMILTON S. HERSHEY MEDICAL CENTERCampe Hill Entrance B.Family Med - General3025 Market StCamp HillPAActive
DSH390256BAChildDSHMILTON S. HERSHEY MEDICAL CENTERHeart & Vascular Services - Cardiology services UPC200 Campus DriveHersheyPAActive
DSH390256BBChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERMedicine Specialties - Medicine specialties200 Campus DriveHersheyPATerminated
DSH390256BCChildDSHMILTON S. HERSHEY MEDICAL CENTEROphthalmology - Ophthalmology200 Campus DriveHersheyPAActive
DSH390256BDChildDSHMILTON S. HERSHEY MEDICAL CENTERPractice Management Clinic – Anesthesia Clinic200 Campus DriveHersheyPAActive
DSH390256BEChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTEROtolaryngology - Head/Neck surgical services200 Campus DriveHersheyPATerminated
DSH390256BFChildDSHMILTON S. HERSHEY MEDICAL CENTERCancer Institute (Practice Site) - Office visits400 University DriveHersheyPAActive
DSH390256BGChildDSHMILTON S. HERSHEY MEDICAL CENTERCancer Institute (Hem/Onc & Infusion) - Hematology/Oncology and Infusion400 University DriveHersheyPAActive
DSH390256BHChildDSHMILTON S. HERSHEY MEDICAL CENTERPediatric Hem/Onc & Infusion - Hematology/Oncology and Infusion600 University DriveHersheyPAActive
DSH390256BJChildDSHMILTON S. HERSHEY MEDICAL CENTERDermatology UPC200 Campus DriveHersheyPAActive
DSH390256BKChildDSHMILTON S. HERSHEY MEDICAL CENTERWest Campus Allergy Asthma & Immunology10 Conference DriveHersheyPAActive
DSH390256BLChildDSHMILTON S. HERSHEY MEDICAL CENTEREndoscopy UPC200 Campus DriveHersheyPAActive
DSH390256BNChildDSHMILTON S. HERSHEY MEDICAL CENTERSurgery Specialties UPC200 Campus DriveHersheyPAActive
DSH390256BPChildDSHMILTON S. HERSHEY MEDICAL CENTERAudiology UPC200 Campus DriveHersheyPAActive
DSH390256BQChildDSHMILTON S. HERSHEY MEDICAL CENTERRenal Dialysis (Peritineal) - Peritineal200 Campus DriveHersheyPAActive
DSH390256BRChildDSHMILTON S. HERSHEY MEDICAL CENTERMedicine Suite - Medicine Specialties200 Campus DriveHersheyPAActive
DSH390256BSChildDSHMILTON S. HERSHEY MEDICAL CENTERMedicine Specialties (Diabetes) - Diabetes Education200 Campus DriveHersheyPAActive
DSH390256BTChildDSHMILTON S. HERSHEY MEDICAL CENTERPENN STATE HERSHEY-LIME SPRINGS - Therapy Services2221 NOLL DRIVELANCASTERPAActive
DSH390256BUChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG - Pediatric Specialties Lancaster1430 Harrisburg PikeLANCASTERPAActive
DSH390256BVChildDSHMILTON S. HERSHEY MEDICAL CENTERPENN STATE HERSHEY-LIME SPRINGS - Infusion2221 NOLL DRIVELANCASTERPAActive
DSH390256BWChildDSHMILTON S. HERSHEY MEDICAL CENTER"PSHMG Lime Springs Specialties"2221 NOLL DRIVELANCASTERPAActive
DSH390256BXChildDSHMILTON S. HERSHEY MEDICAL CENTERPENN STATE HERSHEY-LIME SPRINGS - Audiology2221 NOLL DRIVELANCASTERPAActive
DSH390256BYChildDSHMILTON S. HERSHEY MEDICAL CENTERPSMG HOPE DR 35 - Internal Medicine35 HOPE DRIVEHERSHEYPAActive
DSH390256BZChildDSHMILTON S. HERSHEY MEDICAL CENTERPSMG NYES ROAD - Audiology121 NYES ROADHARRISBURGPAToBeTerminated
DSH390256CChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Camp Hill Specialties3025 Market StCamp HillPAActive
DSH390256CAChildDSHMILTON S. HERSHEY MEDICAL CENTERPSMG HOPE DR 35 - Womens Health35 HOPE DRIVEHERSHEYPAActive
DSH390256CBChildDSHMILTON S. HERSHEY MEDICAL CENTERCampus Drive Suite 1300- Medicine-Pulmonology General - Pulmonology200 Campus Dr.HersheyPAApproved
DSH390256CCChildDSHMILTON S. HERSHEY MEDICAL CENTERCampus Drive Suite 400-Surgery - Multi Specialty - Penn State Health Otolaryngology – Head and Neck Surgery200 Campus Drive,Suite 400HersheyPAApproved
DSH390256CDChildDSHMILTON S. HERSHEY MEDICAL CENTERSurgery Specialties-Surgery - Multi Specialty - Carlino Family IBD Center200 Campus Dr. Suite 3200HersheyPAApproved
DSH390256DChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Harrisburg2626 North Third StreetHarrisburgPAActive
DSH390256EChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Nyes Road II121 Nyes Road Suite FHarrisburgPAActive
DSH390256FChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Nyes Rd Pediatric Cardiology121 Nyes Road Suite DHarrisburgPAActive
DSH390256GChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Nyes Road I121 Nyes Road Suite AHarrisburgPAActive
DSH390256HChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Fishburn Road845 Fishburn RdHersheyPAActive
DSH390256JChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Nyes Road Specialties121 Nyes Rd Suite CHarrisburgPAActive
DSH390256KChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Middletown3100 Schoolhouse RdMiddletownPAActive
DSH390256LChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Nyes Rd Heart & Vascular121 Nyes Road Suite EHarrisburgPAActive
DSH390256MChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Elizabethtown1 Continental DrElizabethtownPAActive
DSH390256NChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Middletown Surgery Specialties3100 Schoolhouse RdMiddletownPAActive
DSH390256PChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Palmyra941 Park DrPalmyraPAActive
DSH390256QChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERPSHCH - Lancaster Outpatient2170 Noll DrLancasterPATerminated
DSH390256RChildDSHMILTON S. HERSHEY MEDICAL CENTERPSHMG Physical Medicine Rehab1135 Old West Chocolate AvenueHummelstownPAActive
DSH390256SChildDSHMILTON S. HERSHEY MEDICAL CENTERNeurosurgery Clinic30 Hope DriveHersheyPAActive
DSH390256TChildDSHMILTON S. HERSHEY MEDICAL CENTERBreast Center30 Hope DriveHersheyPAActive
DSH390256UChildDSHMILTON S. HERSHEY MEDICAL CENTEROrthopedics Clinic30 Hope DriveHersheyPAActive
DSH390256VChildDSHMILTON S. HERSHEY MEDICAL CENTERPediatric Bone & Joint30 Hope DriveHersheyPAActive
DSH390256WChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERCosmetic Surgery5 Capital DriveHarrisburgPATerminated
DSH390256XChildDSHPENN STATE - MILTON S. HERSHEY MEDICAL CENTERPenn State Hershey Internal Medicine35 Hope DriveHersheyPATerminated
DSH390256YChildDSHMILTON S. HERSHEY MEDICAL CENTERNeurology Clinic30 Hope DriveHersheyPAActive
DSH390256ZChildDSHMILTON S. HERSHEY MEDICAL CENTERPenn State Hershey Pediatrics35 Hope DriveHersheyPAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsAuthorizing OfficialUpdateChange RequestSwinko, Paul CHIEF FINANCIAL OFFICER Milton S Hershey Medical Center 7175318794Strucko, Eric Interim Chief Financial Officer Milton S. Hershey Medical Center 717531612212/19/2018 12:17 PM
DetailsStateUpdate To Be TerminatedTerminated10/1/2018 12:05 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 6/30/2018 12:00:00 AM7/18/2018 12:57 PM
DetailsStateUpdateTermination RequestActiveTo Be Terminated7/18/2018 12:57 PM
TerminationsTermination CommentsUpdateTermination Request No longer a covered entity type. Billing status changed from hospital based to non-hospital based7/18/2018 12:57 PM
TerminationsTermination DateUpdateTermination Request 10/1/2018 12:00:00 AM7/18/2018 12:57 PM
TerminationsTermination Effective DateUpdateTermination Request 7/1/2018 12:00:00 AM7/18/2018 12:57 PM
TerminationsTermination ReasonUpdateTermination Request Change of covered entity type (non-hospital)7/18/2018 12:57 PM
DetailsLast Recertification DateUpdateRecertification10/24/2017 2:05:54 PM11/15/2017 3:37:58 PM11/15/2017 3:37 PM
DetailsLast Recertification DateUpdateRecertification8/17/2016 12:00:00 AM10/24/2017 2:05:54 PM10/24/2017 2:05 PM
ContactsPrimary ContactUpdateRecertificationLacroce, Vincent Administrative Director of Pharmacy 7175316378Lacroce, Vincent Administrative Director of Pharmacy Penn State Hershey Medical Center 717531637810/24/2017 1:09 PM
ContactsAuthorizing OfficialUpdate Swinko, Paul CHIEF FINANCIAL OFFICER 7175318794Swinko, Paul CHIEF FINANCIAL OFFICER Milton S Hershey Medical Center 717531879410/5/2017 5:05 PM
ContactsAuthorizing OfficialInsert  Swinko, Paul CHIEF FINANCIAL OFFICER 71753187947/17/2017 7:40 AM
ContactsPrimary ContactInsert  Lacroce, Vincent Administrative Director of Pharmacy 71753163787/4/2017 6:54 AM
ContactsSigned ByInsert  HALEY, KEVIN J. CHIEF FINANCIAL OFFICER 71753184057/4/2017 6:54 AM
AddressesMain AddressInsert   5 Capital Drive STE 203 Harrisburg, PA 17110-94777/4/2017 6:51 AM
AddressesBilling AddressInsert  Penn State Milton S. Hershey Medical Center 500 University Dr Hershey, PA 170337/4/2017 6:51 AM
DetailsLast Recertification DateUpdate 8/5/2015 12:00:00 AM8/17/2016 12:00:00 AM8/17/2016 8:12 AM
DetailsLast Recertification DateUpdate 8/21/2014 12:00:00 AM8/5/2015 12:00:00 AM8/5/2015 5:20 PM
Medicaid BillingNPI: NumberUpdate 1007653100141709462411/18/2014 1:44 PM
DetailsLast Recertification DateUpdate  8/21/2014 12:00:00 AM8/21/2014 1:21 PM
Details340B IDUpdate DSH390256ACDSH390256W9/17/2013 2:55 PM
Details340B IDUpdate ISJMDSH390256YDSH390256AC9/13/2013 12:34 PM
DatesParticipating Approval DateUpdate  9/13/2013 12:00:00 AM9/13/2013 12:34 PM
DetailsStateUpdate PendingActive9/13/2013 12:34 PM
DatesStart DateUpdate  10/1/2013 12:00:00 AM9/13/2013 12:34 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REGISJMDSH390256Y8/4/2013 10:45 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False7/11/2013 4:32 PM
Medicaid BillingMedicaid: NumberInsert  10076531000277/11/2013 4:32 PM
Medicaid BillingMedicaid: StateInsert  PA7/11/2013 4:32 PM
Medicaid BillingNPI: NumberInsert  10076531007/11/2013 4:32 PM
DetailsLast Recertification DateInsert   7/11/2013 4:32 PM
DetailsGrant NumberInsert   7/11/2013 4:32 PM
Details340B IDInsert  OUTPATIENT_ONLINE_REG7/11/2013 4:32 PM
DetailsIs Authorizing Official EHB DataInsert   7/11/2013 4:32 PM
DatesLast Date That 340B Drugs PurchasedInsert   7/11/2013 4:32 PM
DetailsMedicare Provider NumberInsert  3902567/11/2013 4:32 PM
DetailsEntity NameInsert  PENN STATE - MILTON S. HERSHEY MEDICAL CENTER7/11/2013 4:32 PM
DetailsProgram CodeInsert  DSH7/11/2013 4:32 PM
DetailsEntity SubnameInsert  Cosmetic Surgery7/11/2013 4:32 PM
DatesParticipating Approval DateInsert   7/11/2013 4:32 PM
DetailsStateInsert  Pending7/11/2013 4:32 PM
DatesRegistration DateInsert  7/11/2013 12:00:00 AM7/11/2013 4:32 PM
DatesSigned By DateInsert  7/11/2013 12:00:00 AM7/11/2013 4:32 PM
DatesStart DateInsert   7/11/2013 4:32 PM
TerminationsTermination CommentsInsert   7/11/2013 4:32 PM
TerminationsTermination DateInsert   7/11/2013 4:32 PM
TerminationsTermination Effective DateInsert   7/11/2013 4:32 PM
TerminationsTermination ReasonInsert   7/11/2013 4:32 PM