Covered Entity Details

DSH390185A LEHIGH VALLEY HOSPITAL-HAZLETON (Terminated) - information as of 6/16/2025 5:07:23 AM

Main Details

Name

LEHIGH VALLEY HOSPITAL-HAZLETON

Subdivision Name

Healthy Beginnings - HBP - Hometown - 106

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390185A

Medicare Provider Number

390185

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/4/2019

Participating Start Date

4/1/2019

Participating Approval Date

1/31/2019

Last Recertification Date

8/31/2023

Termination Date
Termination Reason

4/1/2024
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

241 Claremont Ave
Tamaqua, PA 18252

Billing Address

Lehigh Valley Hospital - Hazleton
700 East Broad Street
Hazleton, PA 18201

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
PA	1007287190013	1548322720

Shipping Addresses

Shipping Address 1

Lehigh Valley Hospital - Hazleton
700 East Broad Street
Hazleton, PA 18201

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
DSH390185A	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Healthy Beginnings - HBP - Hometown - 106	241 Claremont Ave	Tamaqua	PA	Terminated
DSH390185AA	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Laboratory - HWC Phlebotomy MT TOP	233. S. Mountain Boulevard	Mountain Top	PA	Terminated
DSH390185AB	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Oncology Clinic - IV - Oncology	388 Airport Road	Hazle Twp.	PA	Terminated
DSH390185AC	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Fitness Center - Fitness Center - 100	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185AD	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Cardiac Center - Vascular Lab/HW - 613	50 Moisey drive	Hazleton	PA	Terminated
DSH390185AE	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	HZ Radiation Oncology (1017-00077) - Oncology	772 East Broad Street	Hazleton	PA	Active
DSH390185AF	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	HZ Hematology Oncology (1017-00199) - Oncology	772 East Broad Street	Hazleton	PA	Active
DSH390185B	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Industriaal Medicine - Ind Med Onsite - 111	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185C	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	CAT Scan - CT Scan/HWC - 604	50 Moisey Drive	Hazleton	PA	Active
DSH390185D	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	MRI - HWC MRI - 605	50 Moisey Drive	Hazleton	PA	Active
DSH390185E	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - Dexa Scan/HWC - 626	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185F	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Physical Therapy - HWC Physical Therapy - MT TOP - 656	233 S. Mountain Boulevard	Mountain Top	PA	Terminated
DSH390185G	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Speech Therapy - Speech Thrpy HWC - 603	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185H	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	HZ Infusion (51-619)	772 East Broad Street	Hazleton	PA	Active
DSH390185J	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - Mammography/HWC	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185K	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - Ultrasound - MT TOP	233 S. Mountain Boulevard	Mountain Top	PA	Terminated
DSH390185L	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - HWC RAdiology MT TOP - 652	233 S. Mountain Boulevard	Mountain Top	PA	Terminated
DSH390185M	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Laboratory - Phlebotomy - HWC - 600	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185N	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Cardiac rehabilitation - Cardiac Rehab - 410	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185P	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - Radiology/HWC - 607	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185Q	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Occupational Therapy - OCC Therapy - HWC - 601	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185R	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - Ultrasound/HWC - 608	50 Moisey Drive	Hazleton	PA	Active
DSH390185S	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Electroencephalography - Sleep Lab - 426	8 W. Broad Street, Suite 320	Hazleton	PA	Terminated
DSH390185T	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Healthy Beginnings - Healthy Beginning - 107	20 N. Laurel street, Suite 1B	Hazleton	PA	Active
DSH390185U	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - Nuclear Med/HWC-625	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185V	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Industrial Medicine - Ind Med Clinic	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185W	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Radiology Diagnostic - PET Scans - 455	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185X	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Occupational Therapy - Occupational Therapy MT TOP	233 S. Mountain Boulevard	Mountain Top	PA	Terminated
DSH390185Y	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Physical Therapy - Physical Thry HWC - 602	50 Moisey Drive	Hazleton	PA	Terminated
DSH390185Z	Child	DSH	LEHIGH VALLEY HOSPITAL-HAZLETON	Cardiac Center - Vascular Lab HWC - 612	50 Moisey Drive	Hazleton	PA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		11/19/2023 12:00:00 AM	2/6/2024 7:24 AM
Details	State	Update	Termination Request	Active	To Be Terminated	2/6/2024 7:24 AM
Terminations	Termination Date	Update	Termination Request		4/1/2024 12:00:00 AM	2/6/2024 7:24 AM
Terminations	Termination Effective Date	Update	Termination Request		11/20/2023 12:00:00 AM	2/6/2024 7:24 AM
Terminations	Termination Reason	Update	Termination Request		Hospital Outpatient facility no longer eligible	2/6/2024 7:24 AM
Addresses	Main Address	Update	Recertification	241 Claremont, Ave Tamaqua, PA 18252	241 Claremont Ave Tamaqua, PA 18252	8/31/2023 8:09 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 10:04:00 AM	8/31/2023 8:09:00 AM	8/31/2023 8:09 AM
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	8/9/2023 11:22 AM
Details	Last Recertification Date	Update	Recertification	8/18/2021 10:27:47 AM	8/25/2022 10:04:00 AM	8/25/2022 10:04 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 1:56:26 PM	8/18/2021 10:27:47 AM	8/18/2021 10:27 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/8/2020 1:56 PM
Details	Last Recertification Date	Update	Recertification	8/20/2019 3:13:15 PM	9/8/2020 1:56:26 PM	9/8/2020 1:56 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/9/2020 3:32 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007287190013	4/9/2020 3:32 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	4/9/2020 3:32 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1548322720	4/9/2020 3:32 PM
Details	Last Recertification Date	Update	Recertification		8/20/2019 3:13:15 PM	8/20/2019 3:13 PM
Details	State	Update		Approved	Active	4/1/2019 12:05 AM
Contacts	Signed By	Insert	New Registration		Marchozzi, Thomas Executive Vice President & Chief Financial Officer Lehigh Valley Health Network 4848623943	1/31/2019 9:19 AM
Details	340B ID	Update	New Registration		DSH390185A	1/31/2019 9:19 AM
Details	Entity Subname	Update	New Registration	Healthy Beginnings	Healthy Beginnings - HBP - Hometown - 106	1/31/2019 9:19 AM
Dates	Participating Approval Date	Update	New Registration		1/31/2019 9:19:17 AM	1/31/2019 9:19 AM
Details	State	Update	New Registration	Pending	Approved	1/31/2019 9:19 AM
Dates	Signed By Date	Update	New Registration		1/15/2019 3:23:45 PM	1/31/2019 9:19 AM
Dates	Start Date	Update	New Registration		4/1/2019 12:00:00 AM	1/31/2019 9:19 AM
Addresses	Main Address	Insert	New Registration		241 Claremont, Ave Tamaqua, PA 18252	1/4/2019 3:17 PM
Addresses	Billing Address	Insert	New Registration		Lehigh Valley Hospital - Hazleton 700 East Broad Street Hazleton, PA 18201	1/4/2019 3:17 PM
Addresses	Shipping Address	Insert	New Registration		Lehigh Valley Hospital - Hazleton 700 East Broad Street Hazleton, PA 18201	1/4/2019 3:17 PM
Contacts	Authorizing Official	Insert	New Registration		Marchozzi, Thomas Executive Vice President & Chief Financial Officer Lehigh Valley Health Network 4848623943	1/4/2019 3:17 PM
Contacts	Primary Contact	Insert	New Registration		Parnell, Claude Laurence 340B Program Manager Lehigh Valley Health Network 6104025522	1/4/2019 3:17 PM
Details	Last Recertification Date	Insert	New Registration			1/4/2019 3:17 PM
Details	Grant Number	Insert	New Registration			1/4/2019 3:17 PM
Details	340B ID	Insert	New Registration			1/4/2019 3:17 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/4/2019 3:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/4/2019 3:17 PM
Details	Medicare Provider Number	Insert	New Registration		390185	1/4/2019 3:17 PM
Details	Entity Name	Insert	New Registration		LEHIGH VALLEY HOSPITAL-HAZLETON	1/4/2019 3:17 PM
Details	Program Code	Insert	New Registration		DSH	1/4/2019 3:17 PM
Details	Entity Subname	Insert	New Registration		Healthy Beginnings	1/4/2019 3:17 PM
Dates	Participating Approval Date	Insert	New Registration			1/4/2019 3:17 PM
Details	State	Insert	New Registration		Pending	1/4/2019 3:17 PM
Dates	Registration Date	Insert	New Registration		1/4/2019 3:17:36 PM	1/4/2019 3:17 PM
Dates	Signed By Date	Insert	New Registration			1/4/2019 3:17 PM
Dates	Start Date	Insert	New Registration			1/4/2019 3:17 PM
Terminations	Termination Comments	Insert	New Registration			1/4/2019 3:17 PM
Terminations	Termination Date	Insert	New Registration			1/4/2019 3:17 PM
Terminations	Termination Effective Date	Insert	New Registration			1/4/2019 3:17 PM
Terminations	Termination Reason	Insert	New Registration			1/4/2019 3:17 PM