| Addresses | Billing Address | Insert | Reinstatement | | Einstein Medical Center Montgomery
559 Germantown Pike
East Norriton, PA 19403 | 6/2/2025 1:20 PM |
| Addresses | Shipping Address | Insert | Reinstatement | | Einstein Medical Center Montgomery - Pharmacy
559 West Germantown Pike
East Norriton, PA 19403 | 6/2/2025 1:20 PM |
| Addresses | Shipping Address | Insert | Reinstatement | | Wound Care Center - Einstein Montgomery
633 W Germantown Pike
200
Plymouth Meeting, PA 19462 | 6/2/2025 1:20 PM |
| Contacts | Authorizing Official | Update | Reinstatement | Duffy, Beth
Sr. VP Administrative Services
Jefferson Health
2155277657 | FREY, CARRIE
Director of Finance
Jefferson Health
2156124313 | 6/2/2025 1:20 PM |
| Contacts | Signed By | Update | Reinstatement | Duffy, Beth
Chief Operating Officer
Einstein Medical Center Montgomery
4846227004 | FREY, CARRIE
Director of Finance
Jefferson Health
2156124313 | 6/2/2025 1:20 PM |
| Details | Last Recertification Date | Update | Reinstatement | 8/16/2024 8:15:28 AM | | 6/2/2025 1:20 PM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 11/30/2024 12:00:00 AM | | 6/2/2025 1:20 PM |
| Dates | Participating Approval Date | Update | Reinstatement | 5/5/2016 12:00:00 AM | 6/2/2025 1:20:59 PM | 6/2/2025 1:20 PM |
| Details | State | Update | Reinstatement | Terminated | Approved | 6/2/2025 1:20 PM |
| Dates | Registration Date | Update | Reinstatement | 4/11/2016 12:00:00 AM | 4/15/2025 3:11:54 PM | 6/2/2025 1:20 PM |
| Dates | Signed By Date | Update | Reinstatement | 4/11/2016 12:00:00 AM | 4/15/2025 3:11:55 PM | 6/2/2025 1:20 PM |
| Dates | Start Date | Update | Reinstatement | 7/1/2016 12:00:00 AM | 7/1/2025 12:00:00 AM | 6/2/2025 1:20 PM |
| Terminations | Termination Comments | Update | Reinstatement | 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. | | 6/2/2025 1:20 PM |
| Terminations | Termination Date | Update | Reinstatement | 1/1/2025 12:00:00 AM | | 6/2/2025 1:20 PM |
| Terminations | Termination Effective Date | Update | Reinstatement | 12/2/2024 12:00:00 AM | | 6/2/2025 1:20 PM |
| Terminations | Termination Reason | Update | Reinstatement | DSH percentage below statutory minimum | | 6/2/2025 1:20 PM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 7/1/2016; Terminated 1/1/2025; Reinstated 7/1/2025. | 5/30/2025 11:17 AM |
| 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 | Primary Contact | Update | Profile Change Request | Ottemiller, Dustin
VP, Finance
Thomas Jefferson University Hospitals, Inc.
2155035219 | Ottemiller, Dustin
VP, Finance
Jefferson Health
2155035219 | 9/3/2024 11:17 AM |
| Contacts | Primary Contact | Update | Recertification | Kelly, Eileen
Sr Director 340B Program
Jefferson Health
2152543253 | Ottemiller, Dustin
VP, Finance
Thomas Jefferson University Hospitals, Inc.
2155035219 | 8/16/2024 8:15 AM |
| Details | Last Recertification Date | Update | Recertification | 8/14/2023 6:56:38 AM | 8/16/2024 8:15:28 AM | 8/16/2024 8:15 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 | 8/26/2022 7:11:42 AM | 8/14/2023 6:56:38 AM | 8/14/2023 6:56 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 7:31:16 AM | 8/26/2022 7:11:42 AM | 8/26/2022 7:11 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 5:57:55 AM | 8/22/2021 7:31:16 AM | 8/22/2021 7:31 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1104192590 | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NY | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1104192590 | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | NJ | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1104192590 | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | PA | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1104192590 | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | DE | 8/25/2020 5:57 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1104192590 ( ) | | 8/25/2020 5:57 AM |
| Details | Last Recertification Date | Update | Recertification | 8/24/2019 5:00:34 PM | 8/25/2020 5:57:55 AM | 8/25/2020 5:57 AM |
| Details | Last Recertification Date | Update | Recertification | 8/17/2018 5:29:40 PM | 8/24/2019 5:00:34 PM | 8/24/2019 5:00 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 |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/17/2018 5:29 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 1027435270004 | 8/17/2018 5:29 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | PA | 8/17/2018 5:29 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 1027435270002 (PA) | | 8/17/2018 5:29 PM |
| Details | Last Recertification Date | Update | Recertification | 11/5/2017 7:23:28 AM | 8/17/2018 5:29:40 PM | 8/17/2018 5:29 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 7/16/2018 9:56 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1027435270002 | 7/16/2018 9:56 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | PA | 7/16/2018 9:56 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 7/16/2018 9:56 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1027435270001 | 7/16/2018 9:56 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | PA | 7/16/2018 9:56 PM |
| Details | Last Recertification Date | Update | Recertification | 8/23/2016 12:00:00 AM | 11/5/2017 7:23:28 AM | 11/5/2017 7:23 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 | | |
633 W Germantown Pike
Suite 200
Plymouth Meeting, PA 19462 | 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_59474 | DSH390329A | 5/3/2016 10:56 AM |
| Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_59474 | 4/11/2016 11:45 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 4/11/2016 11:45 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 102743527 | 4/11/2016 11:45 AM |
| Medicaid Billing | Medicaid: State | Insert | | | PA | 4/11/2016 11:45 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1104192590 | 4/11/2016 11:45 AM |
| Details | Last Recertification Date | Insert | | | | 4/11/2016 11:45 AM |
| Details | Grant Number | Insert | | | | 4/11/2016 11:45 AM |
| Details | 340B ID | Insert | | | | 4/11/2016 11:45 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 4/11/2016 11:45 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 4/11/2016 11:45 AM |
| Details | Medicare Provider Number | Insert | | | 390329 | 4/11/2016 11:45 AM |
| Details | Entity Name | Insert | | | EINSTEIN MEDICAL CENTER MONTGOMERY | 4/11/2016 11:45 AM |
| Details | Program Code | Insert | | | DSH | 4/11/2016 11:45 AM |
| Details | Entity Subname | Insert | | | Wound Care Center | 4/11/2016 11:45 AM |
| Dates | Participating Approval Date | Insert | | | | 4/11/2016 11:45 AM |
| Details | State | Insert | | | Pending | 4/11/2016 11:45 AM |
| Dates | Registration Date | Insert | | | 4/11/2016 12:00:00 AM | 4/11/2016 11:45 AM |
| Dates | Signed By Date | Insert | | | 4/11/2016 12:00:00 AM | 4/11/2016 11:45 AM |
| Dates | Start Date | Insert | | | | 4/11/2016 11:45 AM |
| Terminations | Termination Comments | Insert | | | | 4/11/2016 11:45 AM |
| Terminations | Termination Date | Insert | | | | 4/11/2016 11:45 AM |
| Terminations | Termination Effective Date | Insert | | | | 4/11/2016 11:45 AM |
| Terminations | Termination Reason | Insert | | | | 4/11/2016 11:45 AM |