Covered Entity Details

DSH390030S Lehigh Valley Hospital - Schuylkill (Active) - information as of 6/6/2025 12:38:11 PM

Main Details

Name

Lehigh Valley Hospital - Schuylkill

Subdivision Name

EAST NORWEGIAN STREET - Cat Scan

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390030S

Medicare Provider Number

390030

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/14/2020

Participating Start Date

7/1/2020

Participating Approval Date

4/29/2020

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

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

Primary Contact

Lehigh Valley Hospital
Paul Mattern, 340B Program Manager
(610) 402-1007

Addresses

Street Address

700 East Norwegian Street
POTTSVILLE, PA 17901

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
Participated starting 1/1/2019, terminated 4/1/2020. Reinstated 7/1/2020.	04/29/2020

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
PA	1007607250033	1235138405

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
DSH390030A	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital - EAST NORWEGIAN - Ambulatory Surgery	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030AA	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Pathology	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030AB	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital - Recovery Room	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030AC	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Rehab Tamaqua	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030AD	Child	DSH	Lehigh Valley Hospital - Schuylkill	EAST NORWEGIAN STREET - Respiratory	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030AE	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Xray	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030AF	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - Nuclear Medicine - Nuclear Medicine	700 East Norwegian Street	Pottsville	PA	Active
DSH390030AG	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - East Norwegian Street - Outpt Surgery Oper Room - Outpatient Surgery	700 East Norwegian Street	Pottsville	PA	Terminated
DSH390030AH	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - Maternity	700 East Norwegian Street	Pottsville	PA	Terminated
DSH390030AJ	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital - Schuylkill - East Norwegian Street - Nursery	700 East Norwegian Street	Pottsville	PA	Terminated
DSH390030AK	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - East Norwegian Street - ICU	700 East Norwegian Street	Pottsville	PA	Active
DSH390030AL	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital - Schuylkill - East Norwegian Street 6North Medical Surgical	700 East Norwegian Street	Pottsville	PA	Terminated
DSH390030AM	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill -East Norwegian Street - 4North Medical Surgical	700 East Norwegian Street	Pottsville	PA	Terminated
DSH390030AN	Child	DSH	Lehigh Valley Hospital - Schuylkill	Short Procedure Unit - (62402, 10006046) - Short Procedure Unit	700 East Norwegian Street	Pottsville	PA	Terminated
DSH390030AP	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - SKE Heart Station (62423)	700 East Norwegian Street	Pottsville,	PA	Active
DSH390030AQ	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital - Schuylkill - Surgical Staging Area (62506)	700 East Norwegian Street	Pottsville	PA	Active
DSH390030AR	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - 5 North (00003) - Adults and Pediatrics (General Routine Care)	700 East Norwegian Street	Pottsville	PA	Active
DSH390030AS	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - 6 North (00004) - Adults and Pediatrics (General Routine Care)	700 East Norwegian Street	Pottsville	PA	Active
DSH390030B	Child	DSH	Lehigh Valley Hospital - Schuylkill	SKE MRI (62780)	Lehigh Valley Hospital - Schuylkill	Pottsville	PA	Active
DSH390030C	Child	DSH	Schuylkill Medical Center - South Jackson Street	SCHUYLKILL MEDICAL CENTER - SOUTH J - Womens Imaging	171 RED HORSE RD STE 2	POTTSVILLE	PA	Terminated
DSH390030D	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - EEG	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030E	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Ultrasound	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030F	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - EAST NORWEGIAN STREET - Delivery Room	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030G	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - DIALYSIS	700 EAST NORWEGIAN STREET	POTTSVILLE	PA	Terminated
DSH390030H	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Serology	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030J	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Chemistry	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030K	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - EAST NORWEGIAN STREET - Operating Room	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030L	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Blood Bank	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030M	Child	DSH	Lehigh Valley Hospital - Schuylkill	EAST NORWEGIAN STREET - Wound Care	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030N	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Physical Therapy	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030P	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Anesthesia	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030Q	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Bacteriology	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030R	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Cardiopulmonary	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030S	Child	DSH	Lehigh Valley Hospital - Schuylkill	EAST NORWEGIAN STREET - Cat Scan	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030T	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - EKG	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030U	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital - EAST NORWEGIAN STREET - Emergency Room	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030V	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Hematology	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030W	Child	DSH	Lehigh Valley Hospital - Schuylkill	Lehigh Valley Hospital Schuylkill - EAST NORWEGIAN STREET - Infusion Therapy	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030X	Child	DSH	Lehigh Valley Hospital - Schuylkill	EAST NORWEGIAN STREET - Interventional Radiology	700 East Norwegian Street	POTTSVILLE	PA	Active
DSH390030Y	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Laboratory	700 East Norwegian Street	POTTSVILLE	PA	Terminated
DSH390030Z	Child	DSH	Schuylkill Medical Center - South Jackson Street	EAST NORWEGIAN STREET - Occupational Therapy	700 East Norwegian Street	POTTSVILLE	PA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/28/2023 3:43:17 PM	8/30/2024 2:22:48 PM	8/30/2024 2:22 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 9:37:05 AM	8/28/2023 3:43:17 PM	8/28/2023 3:43 PM
Contacts	Primary Contact	Update	PC Change Request	Parnell, Claude Laurence 340B Program Manager Lehigh Valley Health Network 6104025522	Mattern, Paul 340B Program Manager Lehigh Valley Hospital 6104021007	8/10/2023 10:18 AM
Details	Last Recertification Date	Update	Recertification	8/18/2021 2:38:15 PM	8/29/2022 9:37:05 AM	8/29/2022 9:37 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 11:36:14 AM	8/18/2021 2:38:15 PM	8/18/2021 2:38 PM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/8/2020 11:36 AM
Details	Last Recertification Date	Update	Recertification		9/8/2020 11:36:14 AM	9/8/2020 11:36 AM
Details	State	Update		Approved	Active	7/1/2020 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/11/2020 4:11 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007607250033	6/11/2020 4:11 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	6/11/2020 4:11 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1235138405	6/11/2020 4:11 PM
Addresses	Billing Address	Insert	Reinstatement		Lehigh Valley Hospital - Schuylkill 420 South Jackson Street Pottsville, PA 17901	4/29/2020 3:15 PM
Contacts	Signed By	Update	Reinstatement	Boris, Diane N VP Finance LVH - Schuylkill South Jackson Street 5706215093	Molitoris, Stephen Patrick Vice President Lehigh Valley Health Network 4848840974	4/29/2020 3:15 PM
Contacts	Primary Contact	Update	Reinstatement	Koskulitz, Bernie Steven Director Strategic Reimbursement LVHN 5705014933	Parnell, Claude Laurence 340B Program Manager Lehigh Valley Health Network 6104025522	4/29/2020 3:15 PM
Details	Last Recertification Date	Update	Reinstatement	8/27/2019 12:05:36 PM		4/29/2020 3:15 PM
Dates	Last Date That 340B Drugs Purchased	Update	Reinstatement	2/13/2020 12:00:00 AM		4/29/2020 3:15 PM
Details	Entity Name	Update	Reinstatement	Schuylkill Medical Center - South Jackson Street	Lehigh Valley Hospital - Schuylkill	4/29/2020 3:15 PM
Dates	Participating Approval Date	Update	Reinstatement	11/8/2018 3:19:05 PM	4/29/2020 3:15:22 PM	4/29/2020 3:15 PM
Details	State	Update	Reinstatement	Terminated	Approved	4/29/2020 3:15 PM
Dates	Registration Date	Update	Reinstatement	10/12/2018 4:44:48 PM	4/14/2020 2:23:11 PM	4/29/2020 3:15 PM
Dates	Signed By Date	Update	Reinstatement	10/12/2018 4:44:52 PM	4/14/2020 2:23:16 PM	4/29/2020 3:15 PM
Dates	Start Date	Update	Reinstatement	1/1/2019 12:00:00 AM	7/1/2020 12:00:00 AM	4/29/2020 3:15 PM
Terminations	Termination Date	Update	Reinstatement	4/1/2020 12:00:00 AM		4/29/2020 3:15 PM
Terminations	Termination Effective Date	Update	Reinstatement	2/13/2020 12:00:00 AM		4/29/2020 3:15 PM
Terminations	Termination Reason	Update	Reinstatement	Business decision by the Covered Entity		4/29/2020 3:15 PM
Details	Comments Public	Insert	Reinstatement		Participated starting 1/1/2019, terminated 4/1/2020. Reinstated 7/1/2020.	4/29/2020 9:17 AM
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Contacts	Authorizing Official	Update	Change Request	Boris, Diane N VP Finance LVH - Schuylkill South Jackson Street 5706215093	Molitoris, Stephen Patrick Vice President Lehigh Valley Health Network 4848840974	2/28/2020 9:22 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		2/13/2020 12:00:00 AM	2/13/2020 12:07 PM
Details	State	Update	Termination Request	Active	To Be Terminated	2/13/2020 12:07 PM
Terminations	Termination Date	Update	Termination Request		4/1/2020 12:00:00 AM	2/13/2020 12:07 PM
Terminations	Termination Effective Date	Update	Termination Request		2/13/2020 12:00:00 AM	2/13/2020 12:07 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	2/13/2020 12:07 PM
Details	Last Recertification Date	Update	Recertification		8/27/2019 12:05:36 PM	8/27/2019 12:05 PM
Details	State	Update		Approved	Active	1/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Boris, Diane N VP Finance LVH - Schuylkill South Jackson Street 5706215093	11/8/2018 3:19 PM
Details	340B ID	Update	New Registration		DSH390030S	11/8/2018 3:19 PM
Details	Entity Subname	Update	New Registration	EAST NORWEGIAN STREET	EAST NORWEGIAN STREET - Cat Scan	11/8/2018 3:19 PM
Dates	Participating Approval Date	Update	New Registration		11/8/2018 3:19:05 PM	11/8/2018 3:19 PM
Details	State	Update	New Registration	Pending	Approved	11/8/2018 3:19 PM
Dates	Signed By Date	Update	New Registration		10/12/2018 4:44:52 PM	11/8/2018 3:19 PM
Dates	Start Date	Update	New Registration		1/1/2019 12:00:00 AM	11/8/2018 3:19 PM
Addresses	Main Address	Insert	New Registration		700 East Norwegian Street POTTSVILLE, PA 17901	10/12/2018 4:44 PM
Contacts	Authorizing Official	Insert	New Registration		Boris, Diane N VP Finance LVH - Schuylkill South Jackson Street 5706215093	10/12/2018 4:44 PM
Contacts	Primary Contact	Insert	New Registration		Koskulitz, Bernie Steven Director Strategic Reimbursement LVHN 5705014933	10/12/2018 4:44 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2018 4:44 PM
Details	Grant Number	Insert	New Registration			10/12/2018 4:44 PM
Details	340B ID	Insert	New Registration			10/12/2018 4:44 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2018 4:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2018 4:44 PM
Details	Medicare Provider Number	Insert	New Registration		390030	10/12/2018 4:44 PM
Details	Entity Name	Insert	New Registration		Schuylkill Medical Center - South Jackson Street	10/12/2018 4:44 PM
Details	Program Code	Insert	New Registration		DSH	10/12/2018 4:44 PM
Details	Entity Subname	Insert	New Registration		EAST NORWEGIAN STREET	10/12/2018 4:44 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2018 4:44 PM
Details	State	Insert	New Registration		Pending	10/12/2018 4:44 PM
Dates	Registration Date	Insert	New Registration		10/12/2018 4:44:48 PM	10/12/2018 4:44 PM
Dates	Signed By Date	Insert	New Registration			10/12/2018 4:44 PM
Dates	Start Date	Insert	New Registration			10/12/2018 4:44 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2018 4:44 PM
Terminations	Termination Date	Insert	New Registration			10/12/2018 4:44 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2018 4:44 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2018 4:44 PM