Covered Entity Details

RRC390100-00 LANCASTER GENERAL HOSPITAL (Active) - information as of 4/27/2025 1:51:12 AM

Main Details

Name

LANCASTER GENERAL HOSPITAL

Subdivision Name

Type

Rural Referral Center

Rural

Yes

340B ID

RRC390100-00

Medicare Provider Number

390100

Additional Details

Current Program Status

Active

Registration Date

7/2/2019

Participating Start Date

10/1/2019

Participating Approval Date

8/29/2019

Last Recertification Date

9/11/2024

Contacts

Authorizing Official

Penn Medicine Lancaster General Health
Gary Allen Welch, CFO
(717) 544-5658

Primary Contact

Lancaster General Hospital
Matthew W Eberts, Director of Pharmacy Services
(717) 544-7156

Addresses

Street Address

555 NORTH DUKE STREET
LANCASTER, PA 17604-3555

Billing Address

Lancaster General Hospital
Accounts Payable
555 North Duke Street, PO Box 3555
Lancaster, PA 17604-3555

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	1007711750040,1007711750051,1007711750081,1007711750108,1007711750109,1007711750110,1007711750111,1007711750113,1007711750114,1007711750115,1007711750116,1007711750117,1007711750118,1007711750119,1007711750120,1007711750121,1007711750122,1007711750123,1007711750125,1007711750129,1007711750133,1007711750146,1007711750156,1007711750155,1007711750168,1007711750185,1007711750013,1007711750162,1007711750157,1007711750188,1007711750199	1104875103,1245571942,1538290424,1023037090,1457348138,1710460308,1013643303

Shipping Addresses

Shipping Address 1

Lancaster General Hospital
555 North Duke Street
Lancaster, PA 17602-2250

Shipping Address 2

LG Health Convenience Pharmacy
555 North Duke Street
Lancaster, PA 17602-2250

Shipping Address 3

LG Health Convenience Pharmacy Kissel Hill
51 Peters Road
Lititz, PA 17543

Shipping Address 4

Safecor Health
317 New Boston Street
Woburn, MA 01801

Shipping Address 5

LG Health Convenience Pharmacy Suburban Pavillion
2108 Harrisburg Pike
Suite 314
Lancaster, PA 17601

Shipping Address 6

LG Health Convenience Pharmacy Columbia
306 N 7th Street
Columbia, PA 17512

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
RRC390100-01	Child	RRC	LANCASTER GENERAL HOSPITAL	Ann B Barshinger Cancer Institute - ABBCI Lab	2102 Harrisburg Pike	Lancaster	PA	Active
RRC390100-02	Child	RRC	LANCASTER GENERAL HOSPITAL	Ann B Barshinger Cancer Institute - ABBCI Oncology Infusion Center	2102 Harrisburg Pike	Lancaster	PA	Active
RRC390100-03	Child	RRC	LANCASTER GENERAL HOSPITAL	Wound Care and Hyperbaric Services - Hyperbaric Services and Wound Care	2112 Harrisburg Pike	Lancaster	PA	Active
RRC390100-04	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH Kissel Hill - Echocardiogram - Echocardiogram	51 Peters Road	Lititz	PA	Active
RRC390100-05	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - Pain Management - Pain Management	2100 Harrisburg Pike	Lancaster	PA	Active
RRC390100-06	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - Ultrasound - Ultrasound	2100 Harrisburg Pike	Lancaster	PA	Active
RRC390100-07	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - Diagnostic Imaging - Diagnostic Imaging	2100 Harrisburg Pike	Lancaster	PA	Active
RRC390100-08	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - Surgery Center - SP SS OR	2100 Harrisburg Pike	Lancaster	PA	Active
RRC390100-09	Child	RRC	LANCASTER GENERAL HOSPITAL	NEUROSCIENCE INSTITUTE - EEG - Neuroscience EEG	2150 Harrisburg Pike	Lancaster	PA	Terminated
RRC390100-10	Child	RRC	LANCASTER GENERAL HOSPITAL	Diabetes and Nutrition Center - Diabetes and Nutrition	620 North Duke Street	Lancaster	PA	Terminated
RRC390100-11	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH Columbia - CT - Computerized Tomography	306 North Seventh Street	Columbia	PA	Active
RRC390100-12	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Specialty Center Norlanco - Norlanco Diabetes/Nutrition	426 Cloverleaf Road	Elizabethtown	PA	Terminated
RRC390100-13	Child	RRC	LANCASTER GENERAL HOSPITAL	WBH - Maternal Fetal Medicine - Maternal Fetal Medicine - WBOMF	694 Good Drive	Lancaster	PA	Active
RRC390100-14	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH Willow Lakes - CT - Computerized Tomography	212 Willow Valley Lakes Drive	Willow Street	PA	Active
RRC390100-15	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Ephrata - Cardiac Non-Invasive	895 East Main Street	Ephrata	PA	Active
RRC390100-16	Child	RRC	LANCASTER GENERAL HOSPITAL	WBH - Maternal Fetal Medicine Ste 23 - Maternal Fetal Medicine - WBOMS	694 Good Drive	Lancaster	PA	Active
RRC390100-17	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH Kissel Hill - CT - Computerized Tomography	51 Peters Road	Lititz	PA	Active
RRC390100-18	Child	RRC	LANCASTER GENERAL HOSPITAL	Women and Babies Hospital - Operating Room	690 Good Drive	Lancaster	PA	Active
RRC390100-19	Child	RRC	LANCASTER GENERAL HOSPITAL	LG DOP - CT - Computerized Tomography	540 North Duke Street	Lancaster	PA	Active
RRC390100-20	Child	RRC	LANCASTER GENERAL HOSPITAL	Women and Babies Hospital - Computerized Tomography	690 Good Drive	Lancaster	PA	Active
RRC390100-21	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - Surgery Center - Surgery Center	2100 Harrisburg Pike	Lancaster	PA	Terminated
RRC390100-22	Child	RRC	LANCASTER GENERAL HOSPITAL	Medical Infusion Center - Medical Infusion Center	2106 Harrisburg Pike	Lancaster	PA	Active
RRC390100-23	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Parkesburg - Cardiac Non-Invasive	950 Octorara Trail	Parkesburg	PA	Active
RRC390100-24	Child	RRC	LANCASTER GENERAL HOSPITAL	Ann B Barshinger Cancer Institute - Gamma Knife	2102 Harrisburg Pike	Lancaster	PA	Terminated
RRC390100-25	Child	RRC	LANCASTER GENERAL HOSPITAL	Women and Babies Hospital - Labor and Delivery	690 Good Drive	Lancaster	PA	Active
RRC390100-26	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Specialty Center Norlanco - Norlanco Cardiac Non-Invasive	426 Cloverleaf Road	Elizabethtown	PA	Active
RRC390100-27	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH Willow Lakes - Cardiac Rehab - Cardiac Rehab	212 Willow Valley Lakes Drive	Willow Street	PA	Active
RRC390100-28	Child	RRC	LANCASTER GENERAL HOSPITAL	Ann B Barshinger Cancer Institute - ABBCI Radiation Oncology	2102 Harrisburg Pike	Lancaster	PA	Active
RRC390100-29	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - Nuclear Medicine - Nuclear Medicine	2100 Harrisburg Pike	Lancaster	PA	Active
RRC390100-30	Child	RRC	LANCASTER GENERAL HOSPITAL	Women and Babies Hospital - Surgical Services	690 Good Drive	Lancaster	PA	Terminated
RRC390100-31	Child	RRC	LANCASTER GENERAL HOSPITAL	WBH - Maternal Fetal Medicine -Perinatology - Maternal Fetal Medicine - WBOMP	694 Good Drive	Lancaster	PA	Active
RRC390100-32	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH Occupational Medicine - Occupational Medicine	2110 Harrisburg Pike	Lancaster	PA	Active
RRC390100-33	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Norlanco - Norlanco Pharmacy Services	424 Cloverleaf Road	Elizabethtown	PA	Active
RRC390100-34	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Parkesburg - Diabetes/Nutrition	950 Octorara Trail	Parkesburg	PA	Terminated
RRC390100-35	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Center Lebanon - Cardiac Non-Invasive	1701 Cornwall Road	Lebanon	PA	Active
RRC390100-36	Child	RRC	LANCASTER GENERAL HOSPITAL	LG Health Specialty Center Ephrata - Cardiac Non-Invasive	1261 Division Hwy	Ephrata	PA	Active
RRC390100-37	Child	RRC	LANCASTER GENERAL HOSPITAL	Lancaster General Health Harrisburg Avenue - Cardiac Non-Invasive	217 Harrisburg Avenue	Lancaster	PA	Active
RRC390100-38	Child	RRC	LANCASTER GENERAL HOSPITAL	Women and Babies Hospital - Post Anesthesia Care Unit	690 Good Drive	Lancaster	PA	Terminated
RRC390100-39	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - CT - Computerized Tomography	2100 Harrisburg Pike	Lancaster	PA	Active
RRC390100-40	Child	RRC	LANCASTER GENERAL HOSPITAL	WBH - Surgical Services DS - Surgical Services	690 Good Drive	Lancaster	PA	Terminated
RRC390100-41	Child	RRC	LANCASTER GENERAL HOSPITAL	LGH SOP - Cardiac Rehab - Cardiac Rehab	2100 Harrisburg Pike	Lancaster	PA	Active
RRC390100-42	Child	RRC	LANCASTER GENERAL HOSPITAL	LG Health Specialty Center Ephrata - Diabetes/Nutrition	1261 Division Hwy	Ephrata	PA	Terminated
RRC390100-43	Child	RRC	LANCASTER GENERAL HOSPITAL	Columbia Car Non-Invasive - Non Invasive Cardiac	306 North Seventh Street	Columbia	PA	Active
RRC390100-44	Child	RRC	LANCASTER GENERAL HOSPITAL	Norlanco-Heart Vascular Rehab - Cardiac Rehab	424 Cloverleaf Road	Elizabethtown	PA	Active
RRC390100-45	Child	RRC	LANCASTER GENERAL HOSPITAL	Penn Fertility Care Lancaster General Health - Fertility Care	2112 Harrisburg Pike	Lancaster	PA	Active
RRC390100-46	Child	RRC	LANCASTER GENERAL HOSPITAL	ABBCI Pharm Med Mgmt - Medication Education	2102 Harrisburg Pike	Lancaster	PA	Active
RRC390100-47	Child	RRC	LANCASTER GENERAL HOSPITAL	SP Non-Invasive Cardiac - Non-Invasive Cardiac	2100 HARRISBURG PIKE	Lancaster	PA	Active
RRC390100-48	Child	RRC	LANCASTER GENERAL HOSPITAL	Columbia - Pharmacy Services - Pharmacy Med Mgmt - Medication Educatoin	306 N SEVENTH STREET	COLUMBIA	PA	Active
RRC390100-49	Child	RRC	LANCASTER GENERAL HOSPITAL	LG HEALTH HARRISBURG AVENUE - HAO-Lab Testing	217 HARRISBURG AVE	LANCASTER	PA	Active
RRC390100-50	Child	RRC	LANCASTER GENERAL HOSPITAL	LGHP Diabetes and Endocrinology - Diabetes and Endocrinology	2112 Harrisburg Pike	Lancaster	PA	Active
RRC390100-51	Child	RRC	LANCASTER GENERAL HOSPITAL	LG HEALTH DOWNTOWN PAVILION - LG Health Downtown Pavillion Medication Services	540 N DUKE STREET	LANCASTER	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/10/2025 9:41 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007711750199	1/10/2025 9:41 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/10/2025 9:41 AM
Details	Last Recertification Date	Update	Recertification	8/30/2023 8:49:51 AM	9/11/2024 6:22:45 AM	9/11/2024 6:22 AM
Contacts	Authorizing Official	Update	Change Request	Rinehart, Douglas Weldon Vice President & Controller Lancaster General Hospital 7175445398	Welch, Gary Allen CFO Penn Medicine Lancaster General Health 7175445658	2/15/2024 8:57 AM
Details	Last Recertification Date	Update	Recertification	8/29/2022 7:11:06 AM	8/30/2023 8:49:51 AM	8/30/2023 8:49 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007711750013	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007711750162	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007711750157	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007711750188	1/3/2023 12:20 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1023037090	1/3/2023 12:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1457348138	1/3/2023 12:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1710460308	1/3/2023 12:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1013643303	1/3/2023 12:20 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	1/3/2023 12:20 PM
Details	Last Recertification Date	Update	Recertification	8/17/2021 1:47:16 PM	8/29/2022 7:11:06 AM	8/29/2022 7:11 AM
Addresses	Shipping Address	Insert	Change Request		LG Health Convenience Pharmacy Columbia 306 N 7th Street Columbia, PA 17512	8/23/2022 8:19 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/14/2022 10:02 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007711750185	4/14/2022 10:02 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	4/14/2022 10:02 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/13/2022 2:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007711750168	4/13/2022 2:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	4/13/2022 2:35 PM
Details	Last Recertification Date	Update	Recertification	9/9/2020 1:41:19 PM	8/17/2021 1:47:16 PM	8/17/2021 1:47 PM
Addresses	Shipping Address	Delete	Change Request	Women and Babies Hospital of Lancaster General 690 Good Drive Lancaster, PA 17601		1/11/2021 10:37 AM
Addresses	Shipping Address	Delete	Change Request	Lancaster General Health Penn Medicine Medical Infusion Center Pharmacy 2106 Harrisburg Pike 110 Lancaster, PA 17601		1/11/2021 10:37 AM
Addresses	Shipping Address	Delete	Change Request	Lancaster General Hospital Inpatient Pharmacy 555 North Duke Street Lancaster, PA 17602-2250		1/11/2021 10:37 AM
Addresses	Shipping Address	Delete	Change Request	Lancaster General Infusion Center 2102 Harrisburg Pike Lancaster, PA 17601-2644		1/11/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007711750013 (PA)		1/11/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007711750157 (PA)		1/11/2021 10:37 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1023037090 (PA)		1/11/2021 10:37 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1457348138 (PA)		1/11/2021 10:37 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1710460308 (PA)		1/11/2021 10:37 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007279810009 (PA)		9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1538290424 ( )		9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1104875103 ( )		9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1245571942 ( )		9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1023037090 ( )		9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1710460308 ( )		9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1457348138 ( )		9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1023037090	9/9/2020 1:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1104875103	9/9/2020 1:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1245571942	9/9/2020 1:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1457348138	9/9/2020 1:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1538290424	9/9/2020 1:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 1:41 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1710460308	9/9/2020 1:41 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/9/2020 1:41 PM
Details	Last Recertification Date	Update	Recertification		9/9/2020 1:41:19 PM	9/9/2020 1:41 PM
Details	State	Update		Approved	Active	10/1/2019 12:04 AM
Addresses	Shipping Address	Delete	Change Request	Convenience Pharmacy Suburban Pavilion 2108 Harrisburg Pike 314 Lancaster, PA 17601		9/10/2019 9:26 AM
Addresses	Shipping Address	Insert	Change Request		LG Health Convenience Pharmacy Suburban Pavillion 2108 Harrisburg Pike Suite 314 Lancaster, PA 17601	9/10/2019 9:26 AM
Contacts	Signed By	Insert	New Registration		Rinehart, Douglas Weldon Vice President & Controller Lancaster General Hospital 7175445398	8/29/2019 11:19 AM
Details	340B ID	Update	New Registration		RRC390100-00	8/29/2019 11:19 AM
Dates	Participating Approval Date	Update	New Registration		8/29/2019 11:19:59 AM	8/29/2019 11:19 AM
Details	State	Update	New Registration	Pending	Approved	8/29/2019 11:19 AM
Dates	Signed By Date	Update	New Registration		8/28/2019 4:50:23 PM	8/29/2019 11:19 AM
Dates	Start Date	Update	New Registration		10/1/2019 12:00:00 AM	8/29/2019 11:19 AM
Addresses	Main Address	Insert	New Registration		555 NORTH DUKE STREET LANCASTER, PA 17604-3555	7/2/2019 12:29 PM
Addresses	Billing Address	Insert	New Registration		Lancaster General Hospital Accounts Payable 555 North Duke Street, PO Box 3555 Lancaster, PA 17604-3555	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		Lancaster General Hospital 555 North Duke Street Lancaster, PA 17602-2250	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		LG Health Convenience Pharmacy 555 North Duke Street Lancaster, PA 17602-2250	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		LG Health Convenience Pharmacy Kissel Hill 51 Peters Road Lititz, PA 17543	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		Convenience Pharmacy Suburban Pavilion 2108 Harrisburg Pike 314 Lancaster, PA 17601	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		Lancaster General Infusion Center 2102 Harrisburg Pike Lancaster, PA 17601-2644	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		Lancaster General Hospital Inpatient Pharmacy 555 North Duke Street Lancaster, PA 17602-2250	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		Women and Babies Hospital of Lancaster General 690 Good Drive Lancaster, PA 17601	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		Lancaster General Health Penn Medicine Medical Infusion Center Pharmacy 2106 Harrisburg Pike 110 Lancaster, PA 17601	7/2/2019 12:29 PM
Addresses	Shipping Address	Insert	New Registration		Safecor Health 317 New Boston Street Woburn, MA 01801	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750040	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750051	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750081	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750108	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750109	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750110	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750111	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750113	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750114	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750115	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750116	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750117	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750118	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750119	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750120	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750121	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750122	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750123	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750125	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750129	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750133	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750146	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750156	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750155	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750013	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007711750157	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007279810009	7/2/2019 12:29 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/2/2019 12:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538290424	7/2/2019 12:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104875103	7/2/2019 12:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1245571942	7/2/2019 12:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1023037090	7/2/2019 12:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1710460308	7/2/2019 12:29 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1457348138	7/2/2019 12:29 PM
Contacts	Primary Contact	Insert	New Registration		Eberts, Matthew W Director of Pharmacy Services Lancaster General Hospital 7175447156	7/2/2019 12:29 PM
Contacts	Authorizing Official	Insert	New Registration		Rinehart, Douglas Weldon Vice President & Controller Lancaster General Hospital 7175445398	7/2/2019 12:29 PM
Details	Last Recertification Date	Insert	New Registration			7/2/2019 12:29 PM
Details	Grant Number	Insert	New Registration			7/2/2019 12:29 PM
Details	340B ID	Insert	New Registration			7/2/2019 12:29 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/2/2019 12:29 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/2/2019 12:29 PM
Details	Medicare Provider Number	Insert	New Registration		390100	7/2/2019 12:29 PM
Details	Entity Name	Insert	New Registration		LANCASTER GENERAL HOSPITAL	7/2/2019 12:29 PM
Details	Program Code	Insert	New Registration		RRC	7/2/2019 12:29 PM
Details	Entity Subname	Insert	New Registration			7/2/2019 12:29 PM
Dates	Participating Approval Date	Insert	New Registration			7/2/2019 12:29 PM
Details	State	Insert	New Registration		Pending	7/2/2019 12:29 PM
Dates	Registration Date	Insert	New Registration		7/2/2019 12:29:34 PM	7/2/2019 12:29 PM
Dates	Signed By Date	Insert	New Registration			7/2/2019 12:29 PM
Dates	Start Date	Insert	New Registration			7/2/2019 12:29 PM
Terminations	Termination Comments	Insert	New Registration			7/2/2019 12:29 PM
Terminations	Termination Date	Insert	New Registration			7/2/2019 12:29 PM
Terminations	Termination Effective Date	Insert	New Registration			7/2/2019 12:29 PM
Terminations	Termination Reason	Insert	New Registration			7/2/2019 12:29 PM