Covered Entity Details

DSH390201C POCONO MEDICAL CENTER (Terminated) - information as of 5/25/2025 1:01:01 AM

Main Details

Name

POCONO MEDICAL CENTER

Subdivision Name

Bartonsville Health Center – Wound Care - Wound Care - 6737 & 6735

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390201C

Medicare Provider Number

390201

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/13/2018

Participating Start Date

7/1/2018

Participating Approval Date

4/24/2018

Last Recertification Date

8/20/2019

Termination Date
Termination Reason

4/1/2020
Business decision by the Covered Entity

Contacts

Authorizing Official

Lehigh Valley Health Network
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943

Primary Contact

Lehigh Valley Health Network
Stephen Patrick Molitoris, Vice President
(484) 884-0974

Addresses

Street Address

600 Commerce Blvd.
Stroudsburg, PA 18360

Billing Address
Same as Street Address

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?
No

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
DSH390201A	Child	DSH	POCONO MEDICAL CENTER	Mountain Healthcare Radiology – Lab - Lab - 7010	100 Community Boulevard	Tobyhanna	PA	Terminated
DSH390201B	Child	DSH	POCONO MEDICAL CENTER	Bartonsville Health Center – Lab - Lab - 7010	600 Commerce Blvd.	Stroudsburg	PA	Terminated
DSH390201C	Child	DSH	POCONO MEDICAL CENTER	Bartonsville Health Center – Wound Care - Wound Care - 6737 & 6735	600 Commerce Blvd.	Stroudsburg	PA	Terminated
DSH390201D	Child	DSH	POCONO MEDICAL CENTER	Bartonsville Health Center – Radiology - Radiology - 7212,7222,7242	600 Commerce Blvd.	Stroudsburg	PA	Terminated
DSH390201E	Child	DSH	POCONO MEDICAL CENTER	Mountain Healthcare Radiology – Radiology - Radiology - 7211, 7221	100 Community Boulevard	Tobyhanna	PA	Terminated
DSH390201F	Child	DSH	POCONO MEDICAL CENTER	Mountain Healthcare Radiology – Cat Scan - Cat Scan - 7231	100 Community Boulevard	Tobyhanna	PA	Terminated
DSH390201G	Child	DSH	POCONO MEDICAL CENTER	West End Health Center - Radiology - 7240 & 4240	120 Burrus Boulevard	Brodheadsville	PA	Terminated
DSH390201H	Child	DSH	POCONO MEDICAL CENTER	Bartonsville Health Center – MRI - MRI 7292	600 Commerce Blvd.	Stroudsburg	PA	Terminated
DSH390201J	Child	DSH	POCONO MEDICAL CENTER	Mountain Healthcare Radiology – MRI - MRI - 7291	100 Community Boulevard	Tobyhanna	PA	Terminated
DSH390201K	Child	DSH	POCONO MEDICAL CENTER	Advanced Radiology Services & Center for Women's Well-Being - MRI - MRI - 7291	447 Office Plaza 400 Plaza Court, Suite C	East Stroudsburg	PA	Terminated
DSH390201L	Child	DSH	POCONO MEDICAL CENTER	Bartonsville Health Center – Cat Scan - Cat Scan - 7232	600 Commerce Blvd.	Stroudsburg	PA	Terminated
DSH390201M	Child	DSH	POCONO MEDICAL CENTER	Advanced Radiology Services & Center for Women's Well-Being - Radiology - Radiology - 7211, 7221	447 Office Plaza 400 Plaza Court, Suite C	East Stroudsburg	PA	Terminated
DSH390201N	Child	DSH	POCONO MEDICAL CENTER	Advanced Radiology Services & Center for Women's Well-Being - Cat Scan - Cat Scan - 7231	447 Office Plaza 400 Plaza Court, Suite C	East Stroudsburg	PA	Terminated
DSH390201P	Child	DSH	POCONO MEDICAL CENTER	Dale & Frances Cancer Center - Cancer Center- 7320 & 4320	181 East Brown Street	East Stroudsburg	PA	Active
DSH390201Q	Child	DSH	POCONO MEDICAL CENTER	LVH Hematology Oncology - Pocono (00265) - Hematology Oncology	181 East Brown Street, 2nd Floor	East Stroudsburg	PA	Active
DSH390201R	Child	DSH	POCONO MEDICAL CENTER	LVH Surgical Oncology - Pocono (00266) - Surgical Oncology	181 East Brown Street, 2nd Floor	East Stroudsburg	PA	Active
DSH390201S	Child	DSH	POCONO MEDICAL CENTER	LVH Gynecologic Oncology - Pocono (00267) - Gynecologic Oncology	181 East Brown Street, 2nd Floor	East Stroudsburg	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/31/2019 12:00:00 AM	1/17/2020 9:43 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/17/2020 9:43 AM
Terminations	Termination Date	Update	Termination Request		4/1/2020 12:00:00 AM	1/17/2020 9:43 AM
Terminations	Termination Effective Date	Update	Termination Request		1/1/2020 12:00:00 AM	1/17/2020 9:43 AM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	1/17/2020 9:43 AM
Details	Last Recertification Date	Update	Recertification	9/4/2018 3:21:02 PM	8/20/2019 3:21:21 PM	8/20/2019 3:21 PM
Contacts	Primary Contact	Update	Profile Change Request	Molitoris, Stephen Patrick Administrator Lehigh Valley Health Network 4848840974	Molitoris, Stephen Patrick Vice President Lehigh Valley Health Network 4848840974	8/20/2019 1:44 PM
Details	Last Recertification Date	Update	Recertification		9/4/2018 3:21:02 PM	9/4/2018 3:21 PM
Details	State	Update		Approved	Active	7/1/2018 12:00 AM
Contacts	Signed By	Insert	New Registration		Marchozzi, Thomas Executive Vice President & Chief Financial Officer Lehigh Valley Health Network 4848623943	4/24/2018 1:58 PM
Details	340B ID	Update	New Registration		DSH390201C	4/24/2018 1:58 PM
Details	Entity Subname	Update	New Registration	Bartonsville Health Center – Wound Care	Bartonsville Health Center – Wound Care - Wound Care - 6737 & 6735	4/24/2018 1:58 PM
Dates	Participating Approval Date	Update	New Registration		4/24/2018 1:58:03 PM	4/24/2018 1:58 PM
Details	State	Update	New Registration	Pending	Approved	4/24/2018 1:58 PM
Dates	Signed By Date	Update	New Registration		4/13/2018 3:40:43 PM	4/24/2018 1:58 PM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	4/24/2018 1:58 PM
Addresses	Main Address	Insert	New Registration		600 Commerce Blvd. Stroudsburg, PA 18360	4/13/2018 3:40 PM
Contacts	Primary Contact	Insert	New Registration		Molitoris, Stephen Patrick Administrator Lehigh Valley Health Network 4848840974	4/13/2018 3:40 PM
Contacts	Authorizing Official	Insert	New Registration		Marchozzi, Thomas Executive Vice President & Chief Financial Officer Lehigh Valley Health Network 4848623943	4/13/2018 3:40 PM
Details	Last Recertification Date	Insert	New Registration			4/13/2018 3:40 PM
Details	Grant Number	Insert	New Registration			4/13/2018 3:40 PM
Details	340B ID	Insert	New Registration			4/13/2018 3:40 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/13/2018 3:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/13/2018 3:40 PM
Details	Medicare Provider Number	Insert	New Registration		390201	4/13/2018 3:40 PM
Details	Entity Name	Insert	New Registration		POCONO MEDICAL CENTER	4/13/2018 3:40 PM
Details	Program Code	Insert	New Registration		DSH	4/13/2018 3:40 PM
Details	Entity Subname	Insert	New Registration		Bartonsville Health Center – Wound Care	4/13/2018 3:40 PM
Dates	Participating Approval Date	Insert	New Registration			4/13/2018 3:40 PM
Details	State	Insert	New Registration		Pending	4/13/2018 3:40 PM
Dates	Registration Date	Insert	New Registration		4/13/2018 3:40:39 PM	4/13/2018 3:40 PM
Dates	Signed By Date	Insert	New Registration			4/13/2018 3:40 PM
Dates	Start Date	Insert	New Registration			4/13/2018 3:40 PM
Terminations	Termination Comments	Insert	New Registration			4/13/2018 3:40 PM
Terminations	Termination Date	Insert	New Registration			4/13/2018 3:40 PM
Terminations	Termination Effective Date	Insert	New Registration			4/13/2018 3:40 PM
Terminations	Termination Reason	Insert	New Registration			4/13/2018 3:40 PM