Covered Entity Details

DSH390329B EINSTEIN MEDICAL CENTER MONTGOMERY (Terminated) - information as of 5/3/2025 11:30:53 PM

Main Details

Name

EINSTEIN MEDICAL CENTER MONTGOMERY

Subdivision Name

Medical Oncology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390329B

Medicare Provider Number

390329

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/11/2016

Participating Start Date

7/1/2016

Participating Approval Date

5/5/2016

Last Recertification Date

8/15/2024

Termination Date
Termination Reason

1/1/2025
DSH percentage below statutory minimum

Contacts

Authorizing Official

Jefferson Health
Beth Duffy, Sr. VP Administrative Services
(215) 527-7657

Primary Contact

Jefferson Health
Eileen Kelly, Sr Director 340B Program
(215) 254-3253

Addresses

Street Address

609 West Germantown Pike
Braemer Building, Suite 280
East Norriton, PA 19403

Billing Address

Einstein Medical Center Montgomery
559 West Germantown Pike
East Norriton, PA 19403

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
NJ	0592226	1104192590
NY	04826046	1104192590
DE	250671385	1104192590
PA	102743527,1027435270001,1027435270002	1104192590

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
DSH390329A	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Wound Care Center	633 W Germantown Pike	Plymouth Meeting	PA	Terminated
DSH390329B	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Medical Oncology	609 West Germantown Pike	East Norriton	PA	Terminated
DSH390329C	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Radiology-Solis Mammo Women's Center	700 WEST GERMANTOWN PIKE	EAST NORRITON	PA	Terminated
DSH390329D	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Radiology-Collegeville	100 MARKET STREET	COLLEGEVILLE	PA	Terminated
DSH390329E	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Sleep Lab	633 W Germantown Pike	Plymouth Meeting	PA	Terminated
DSH390329F	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Radiation Oncology	609 West Germantown Pike	East Norriton	PA	Terminated
DSH390329G	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Antenatal Testing Unit	609 West Germantown Pike	East Norriton	PA	Terminated
DSH390329H	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	Short Procedure Unit Braemer	609 West Germantown Pike	East Norriton	PA	Terminated
DSH390329J	Child	DSH	EINSTEIN MEDICAL CENTER MONTGOMERY	King of Prussia Imaging - Radiology	210 Mall Blvd	King of Prussia	PA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/30/2024 12:00:00 AM	12/4/2024 7:35 AM
Details	State	Update	Termination Request	Active	To Be Terminated	12/4/2024 7:35 AM
Terminations	Termination Comments	Update	Termination Request		The most recent Medicare cost report was filed on 12/2/2024 showed DHS percentage below statutory minimum. Covered entity stopped purchasing 340B as of 11/30/2024.	12/4/2024 7:35 AM
Terminations	Termination Date	Update	Termination Request		1/1/2025 12:00:00 AM	12/4/2024 7:35 AM
Terminations	Termination Effective Date	Update	Termination Request		12/2/2024 12:00:00 AM	12/4/2024 7:35 AM
Terminations	Termination Reason	Update	Termination Request		DSH percentage below statutory minimum	12/4/2024 7:35 AM
Contacts	Authorizing Official	Update	Profile Change Request	Duffy, Beth President & COO - EMCM, EMP Jefferson Health 4846227004	Duffy, Beth Sr. VP Administrative Services Jefferson Health 2155277657	8/16/2024 7:26 AM
Details	Last Recertification Date	Update	Recertification	8/14/2023 6:59:54 AM	8/15/2024 4:33:56 PM	8/15/2024 4:33 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 7:10:30 AM	8/14/2023 6:59:54 AM	8/14/2023 6:59 AM
Contacts	Primary Contact	Update	Group Change Request	Kelly, Eileen Director, Revenue Cycle Analysi Einstein Medical Center Montgomery 2152543253	Kelly, Eileen Sr Director 340B Program Jefferson Health 2152543253	8/10/2023 10:56 AM
Contacts	Authorizing Official	Update	Change Request	Duffy, Beth Chief Operating Officer Einstein Medical Center Montgomery 4846227004	Duffy, Beth President & COO - EMCM, EMP Jefferson Health 4846227004	11/15/2022 4:47 PM
Details	Last Recertification Date	Update	Recertification	8/22/2021 7:28:16 AM	8/26/2022 7:10:30 AM	8/26/2022 7:10 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	200009742 (DE)		4/11/2022 1:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/11/2022 1:54 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		250671385	4/11/2022 1:54 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DE	4/11/2022 1:54 PM
Details	Last Recertification Date	Update	Recertification	8/25/2020 5:58:08 AM	8/22/2021 7:28:16 AM	8/22/2021 7:28 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104192590	8/25/2020 5:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/25/2020 5:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104192590	8/25/2020 5:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		NJ	8/25/2020 5:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104192590	8/25/2020 5:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/25/2020 5:58 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1104192590	8/25/2020 5:58 AM
Medicaid Billing	NPI: State	Insert	Recertification		DE	8/25/2020 5:58 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1104192590 ( )		8/25/2020 5:58 AM
Details	Last Recertification Date	Update	Recertification	8/24/2019 5:01:29 PM	8/25/2020 5:58:08 AM	8/25/2020 5:58 AM
Addresses	Main Address	Update	Change Request	559 West Germantown Pike Braemer Building, Suite 280 East Norriton, PA 19403	609 West Germantown Pike Braemer Building, Suite 280 East Norriton, PA 19403	10/25/2019 12:33 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 3:56:16 PM	8/24/2019 5:01:29 PM	8/24/2019 5:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0592226	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		04826046	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		200009742	4/2/2019 5:48 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		DE	4/2/2019 5:48 PM
Addresses	Main Address	Update	Recertification	559 Germantown Pike Braemer Building, Suite 280 East Norriton, PA 19403	559 West Germantown Pike Braemer Building, Suite 280 East Norriton, PA 19403	8/22/2018 3:56 PM
Addresses	Billing Address	Update	Recertification	Einstein Medical Center Montgomery 559 Germantown Pike East Norriton, PA 19403	Einstein Medical Center Montgomery 559 West Germantown Pike East Norriton, PA 19403	8/22/2018 3:56 PM
Details	Last Recertification Date	Update	Recertification	11/5/2017 7:24:45 AM	8/22/2018 3:56:16 PM	8/22/2018 3:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 9:55 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1027435270001	7/16/2018 9:55 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	7/16/2018 9:55 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/16/2018 9:55 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1027435270002	7/16/2018 9:55 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	7/16/2018 9:55 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	11/5/2017 7:24:45 AM	11/5/2017 7:24 AM
Contacts	Authorizing Official	Update		Duffy, Beth Chief Operating Officer 4846227004	Duffy, Beth Chief Operating Officer Einstein Medical Center Montgomery 4846227004	10/3/2017 7:57 AM
Contacts	Signed By	Update		Duffy, Beth Chief Operating Officer 4846227004	Duffy, Beth Chief Operating Officer Einstein Medical Center Montgomery 4846227004	10/3/2017 7:57 AM
Contacts	Primary Contact	Update		Kelly, Eileen Director, Revenue Cycle Analysi 2152543253	Kelly, Eileen Director, Revenue Cycle Analysi Einstein Medical Center Montgomery 2152543253	10/2/2017 9:18 AM
Contacts	Authorizing Official	Insert			Duffy, Beth Chief Operating Officer 4846227004	7/5/2017 10:04 PM
Contacts	Signed By	Insert			Duffy, Beth Chief Operating Officer 4846227004	7/5/2017 10:04 PM
Contacts	Primary Contact	Insert			Kelly, Eileen Director, Revenue Cycle Analysi 2152543253	4/20/2017 5:41 PM
Addresses	Main Address	Insert			559 Germantown Pike Braemer Building, Suite 280 East Norriton, PA 19403	1/6/2017 5:46 PM
Addresses	Billing Address	Insert			Einstein Medical Center Montgomery 559 Germantown Pike East Norriton, PA 19403	1/6/2017 5:46 PM
Details	Last Recertification Date	Update			8/23/2016 12:00:00 AM	8/23/2016 12:20 PM
Dates	Participating Approval Date	Update			5/5/2016 12:00:00 AM	5/5/2016 1:10 PM
Details	State	Update		Pending	Active	5/5/2016 1:10 PM
Dates	Start Date	Update			7/1/2016 12:00:00 AM	5/5/2016 1:10 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_59469	DSH390329B	5/3/2016 10:58 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_59469	4/11/2016 11:35 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/11/2016 11:35 AM
Medicaid Billing	Medicaid: Number	Insert			102743527	4/11/2016 11:35 AM
Medicaid Billing	Medicaid: State	Insert			PA	4/11/2016 11:35 AM
Medicaid Billing	NPI: Number	Insert			1104192590	4/11/2016 11:35 AM
Details	Last Recertification Date	Insert				4/11/2016 11:35 AM
Details	Grant Number	Insert				4/11/2016 11:35 AM
Details	340B ID	Insert				4/11/2016 11:35 AM
Details	Is Authorizing Official EHB Data	Insert				4/11/2016 11:35 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/11/2016 11:35 AM
Details	Medicare Provider Number	Insert			390329	4/11/2016 11:35 AM
Details	Entity Name	Insert			EINSTEIN MEDICAL CENTER MONTGOMERY	4/11/2016 11:35 AM
Details	Program Code	Insert			DSH	4/11/2016 11:35 AM
Details	Entity Subname	Insert			Medical Oncology	4/11/2016 11:35 AM
Dates	Participating Approval Date	Insert				4/11/2016 11:35 AM
Details	State	Insert			Pending	4/11/2016 11:35 AM
Dates	Registration Date	Insert			4/11/2016 12:00:00 AM	4/11/2016 11:35 AM
Dates	Signed By Date	Insert			4/11/2016 12:00:00 AM	4/11/2016 11:35 AM
Dates	Start Date	Insert				4/11/2016 11:35 AM
Terminations	Termination Comments	Insert				4/11/2016 11:35 AM
Terminations	Termination Date	Insert				4/11/2016 11:35 AM
Terminations	Termination Effective Date	Insert				4/11/2016 11:35 AM
Terminations	Termination Reason	Insert				4/11/2016 11:35 AM