Covered Entity Details

DSH390133G LEHIGH VALLEY (Active) - information as of 4/25/2025 6:33:48 PM

Main Details

Name

LEHIGH VALLEY

Subdivision Name

Lehigh Valley Hospital - 17 ED (02500)

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390133G

Medicare Provider Number

390133

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/6/2022

Participating Start Date

1/1/2023

Participating Approval Date

11/18/2022

Last Recertification Date

8/29/2024

Contacts

Authorizing Official

Lehigh Valley Health Network
Robert Thomas, Sr. Vice President Finance & Chief Accounting Officer
(484) 884-0901

Primary Contact

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

Addresses

Street Address

1627 W Chew Street, Ground Floor
Allentown, PA 18102

Billing Address

Lehigh Valley Hospital
2100 Mack Boulevard
Allentown, PA 18103

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	1007660210023	1164400131

Shipping Addresses

Shipping Address 1

Lehigh Valley Hospital
1627 Chew Street
Allentown, PA 18102

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
DSH390133A	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 Hepatitis Care Center (02106)	1627 Chew Street, 3rd Floor	Allentown	PA	Active
DSH390133AA	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Onc Infusion MPA (18-535)	2545 Schoenersville Road, North Entrance, First Floor	Bethlehem	PA	Active
DSH390133AB	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M MRI (18725)	2545 Schoenersville Road, Building #85	Bethlehem	PA	Active
DSH390133AC	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Neurodiagnostics (18714)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AD	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Nuclear Medicine (18729)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AE	Child	DSH	LEHIGH VALLEY	Lehigh VAaley Hospital - M OR (18660)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AF	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M PACU (18665)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AG	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Pain Management (18681)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AH	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M RHC Medical (18615)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AJ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M SPM (18680)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AK	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M LD (18127)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133AL	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC Children's ASC (02257)	1210 S. Cedar Crest Blvd.	Allentown	PA	Active
DSH390133AM	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - Children's Cancer Center (02316)	1210 S. Cedar Crest Blvd	Allentown	PA	Active
DSH390133AN	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - Cancer Support Services (02605)	1240 S. Cedar Crest Blvd.	Allentown	PA	Active
DSH390133AP	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC ONC INFUSION MPA (02535)	1240 S. Cedar Crest Blvd., 1st Floor	Allentown	PA	Active
DSH390133AQ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC Pain Management (02482)	1240 S. Cedar Crest Boulevard	Allentown	PA	Active
DSH390133AR	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC Radiation Oncology (02468)	1240 S. Cedar Crest Blvd.	Allentown	PA	Active
DSH390133AS	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC 1247 LVH Imaging (02780)	1247 S Cedar Crest Blvd, Suite 102	Allentown	PA	Active
DSH390133AT	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC 1250 LVH Imaging CT (02784)	1250 SOUTH CEDAR CREST BOULEVARD	ALLENTOWN	PA	Active
DSH390133AU	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 1770 IMAG MRI (18144)	1770 BATHGATE ROAD	BETHLEHEM	PA	Active
DSH390133AV	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Cardiac Diag. Center (18705)	2649 Schoenersville Road	BETHLEHEM	PA	Active
DSH390133AW	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - TL OR (02207)	4815 WEST TILGHMAN STREET	ALLENTOWN	PA	Active
DSH390133AX	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - TL POST OPERATIVE UNIT (02209)	4815 WEST TILGHMAN STREET	Allentown	PA	Active
DSH390133AY	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - TL Express Care (02212)	4825 TILGHMAN STREET	ALLENTOWN	PA	Active
DSH390133AZ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - TLL Surgery Center OR (02214)	4825 WEST TILGHMAN STREET	ALLENTOWN	PA	Active
DSH390133B	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 Dental Clinic (02510)	1627 W Chew Street, 1st Floor	Allentown	PA	Active
DSH390133BA	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Cancer Support Services (02536)	2545 SCHOENERSVILLE ROAD	BETHLEHEM	PA	Active
DSH390133BB	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 Mental Health Clinic (02590)	1627 West Chew Street, 3rd Floor	ALLENTOWN	PA	Terminated
DSH390133BC	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC BH ADOL TRNS PRT HSP (02597)	1255 SOUTH CEDAR CREST BOULEVARD, Suite 1500	ALLENTOWN	PA	Active
DSH390133BD	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC GYN ONC (02589)	1240 SOUTH CEDAR CREST BOULEVARD, SUITE 401	ALLENTOWN	PA	Active
DSH390133BE	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC HEM ONC (02588)	1240 SOUTH CEDAR CREST BOULEVARD, SUITE 401	ALLENTOWN	PA	Active
DSH390133BF	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC 1250 Neurosurg (02586)	1250 SOUTH CEDAR CREST BOULEVARD, SUITE 400	ALLENTOWN	PA	Active
DSH390133BG	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC 1250 CT SURG (02584)	1250 SOUTH CEDAR CREST BOULEVARD, SUITE 310	Allentown	PA	Active
DSH390133BH	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC 1250 CARD (02583)	1250 SOUTH CEDAR CREST BOULEVARD, SUITE 300	ALLENTOWN	PA	Active
DSH390133BJ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC 1250 NEURO (02585)	1250 SOUTH CEDAR CREST BOULEVARD, SUITE 405	ALLENTOWN	PA	Active
DSH390133BK	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO OR (12403)	3780 Hecktown Rd, 1st Floor	Easton	PA	Active
DSH390133BL	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO Respiratory Care (12421)	3780 Hecktown Rd, 1st Floor	Easton	PA	Active
DSH390133BM	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO ED (12501)	3780 Hecktown Rd, 1st Floor	Easton	PA	Active
DSH390133BN	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO PACU/STAGING (12208)	3780 Hecktown Rd, 1st Floor	Easton	PA	Active
DSH390133BP	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO Pulmonary Function (12422)	3780 Hecktown Rd, 1st Floor	Easton	PA	Active
DSH390133BQ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO Heart Station (12412)	3780 Hecktown Rd, 1st Floor	Easton	PA	Active
DSH390133BR	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO Radiation Oncology (12468)	3788 Hecktown Rd, 1st Floor, Suite 110	Easton	PA	Active
DSH390133BS	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO ONC INFUSION (12535)	3788 Hecktown Rd, 1st Floor, Suite 100	Easton	PA	Active
DSH390133BT	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO Cardiac Diagnostic Center (12127)	3794 Hecktown Rd, 2nd Floor, Suite 260	Easton	PA	Active
DSH390133BU	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CRB ED (13501)	2128 Blakeslee BLVD DR East	Lehighton	PA	Active
DSH390133BV	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CRB ONC Infusion (13535)	2226 Blakeslee BLVD DR East 1st Floor	Lehighton	PA	Active
DSH390133BW	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CRB OR (13403)	2128 Blakeslee BLVD DR East	Lehighton	PA	Active
DSH390133BX	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CRB PACU/STAGING (13208)	2128 E Blakeslee BLVD DR East	Lehighton	PA	Active
DSH390133BY	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHB 2310 Staging (09242)	2310 Highland Avenue	Bethlehem	PA	Active
DSH390133BZ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHB 2310 OR (09402)	2310 Highland Avenue	Bethlehem	PA	Active
DSH390133C	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 ASU (02504)	1627 W. Chew Street, 2nd floor	Allentown	PA	Active
DSH390133CA	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHB 2310 PACU (09242)	2310 Highland Avenue	Bethlehem	PA	Active
DSH390133CB	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHB 2310 SPU (09402)	2310 Highland Avenue	Beyhlehem	PA	Active
DSH390133CC	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CRB 2A MED/SURG UNIT (13170)	2128 Blakeslee BLVD DR East	Lehighton	PA	Active
DSH390133CD	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO 1A Med/SURG UNIT (12169)	3780 Hecktown Rd, 1st Floor	Easton	PA	Active
DSH390133CE	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHB 2310 1A (09552)	2310 Highland Avenue	Bethlehem	PA	Active
DSH390133CF	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO 2A MED/SURG UNIT (12170)	3780 Hecktown Rd, 2nd Floor	EASTON	PA	Terminated
DSH390133CG	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CRB Cardiac Diagnostic Center (13127)	2128 Blakeslee BLVD DR East 1st Floor"	Lehighton	PA	Active
DSH390133CH	Child	DSH	LEHIGH VALLEY	LEHIGH VALLEY HOSPITAL - CC AUDIOLOGY (02479)	1210 South Cedar Crest Boulevard	Allentown	PA	Active
DSH390133CJ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - TL Staging/PACU	4815 West Tilghman Street	Allentown	PA	Active
DSH390133CK	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Dialysis (18641)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133CL	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC CARD DIAG CENTER (02127)	1250 South Cedar Crest Boulevard	Allentown	PA	Active
DSH390133CM	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Perinatal Evaluation Unit (PNU -18125)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133CN	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - MBH Ment Hlth Clin Muh (18792) - Mental Health Clinic	2604 Schoenersville Road	Bethlehem	PA	Active
DSH390133CP	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HAS RHEUM (02696) - Rheumatology	798 Hausman Road, 3rd Floor, Suite 300	Allentown	PA	Active
DSH390133CQ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 MRI (09718) - CHA 1503 MRI (09718)	1503 N. Cedar Crest Boulevard, 1st Floor	Allentown	PA	Active
DSH390133CR	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 PACU (09241) - CHA 1503 PACU (09241)	1503 N. Cedar Crest Boulevard, 3rd Floor	Allentown	PA	Active
DSH390133CS	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 DIAG RADIOL (09572) - CHA 1503 DIAG RADIOL (09572)	1503 N. Cedar Crest Boulevard, 2nd Floor	Allentown	PA	Active
DSH390133CT	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 STAGING (09241) - CHA 1503 STAGING (09241)	1503 N. Cedar Crest Boulevard, 3rd Floor	Allentown	PA	Active
DSH390133CU	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 OR (09403) - OR	1503 N. Cedar Crest Boulevard, 3rd Floor	Allentown	PA	Active
DSH390133CV	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 VAS LAB Ultrasound (09542) - Ultrasound	1503 N. Cedar Crest Boulevard, 1st Floor	Allentown	PA	Active
DSH390133CW	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 3A Med/Surg Unit (09551) - Med/Surg Unit	1503 N. Cedar Crest Boulevard, 2nd Floor	Allentown	PA	Active
DSH390133CX	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CHA 1503 2A Med/Surg Unit (09551) - Med/Surg Unit	1503 N. Cedar Crest Boulevard, 2nd Floor	Allentown	PA	Active
DSH390133CY	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Rad Oncology (02746/18468) - Oncology	2545 Schoenersville Road, Kolb Bldg 1st Flr	Bethlehem	PA	Active
DSH390133CZ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Pulm Function (18736) - Pulmonology	2545 Schoenersville Road, 2nd Flr	Bethlehem	PA	Active
DSH390133D	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 OR (02505)	1627 W Chew Street, 2nd Floor	Allentown	PA	Active
DSH390133DA	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M ICU North (06061) - Intensive Care Unit	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133DB	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC Neuro-Ophthalm (09136) - Neurology	1250 South Cedar Crest Blvd, Ste 405	Allentown	PA	Active
DSH390133DC	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC Stem Cell Office (09330) - Hematology Oncology	1240 South Cedar Crest Blvd, 4th Floor	Allentown	PA	Active
DSH390133DD	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Gynecologic Oncology (06244) - Oncology	2545 Schoenersville Road, Ste 300	Bethlehem	PA	Active
DSH390133DE	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO Hematology Oncology (02068) - Hematology Oncology	3788 Hecktown Road, 2nd Floor, Ste 210	Easton	PA	Active
DSH390133DF	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO Surgical Oncology (02069) - Surgical Oncology	3788 Hecktown Road, Suite 200	Easton	PA	Active
DSH390133DG	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - B 2300 Rheumatology (00127) - Rheumatology	2300 Highland Avenue, Building A, 2nd Floor	Bethlehem	PA	Active
DSH390133DH	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Neurosurgery (06243) - Neurosurgery	1770 Bathgate Road, Ste 402	Bethlehem	PA	Active
DSH390133DJ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Neurology (06242) - Neurology	1770 Bathgate Road, Ste 403	Bethlehem	PA	Active
DSH390133DK	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CC Surgical Oncology (09794) - Surgical Oncology	1240 South Cedar Crest Blvd, Ste 410	Allentown	PA	Active
DSH390133DL	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Surgical Oncology (06246) - Surgical Oncology	2545 Schoenersville Road, Ste 300	Bethlehem	PA	Active
DSH390133DM	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Hematology Oncology (06245) - Hematology Oncology	2545 Schoenersville Road, Ste 300	Bethlehem	PA	Active
DSH390133DN	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - CRB ICU (04055) - Intensive Care Unit	2128 Blakeslee Boulevard Drive East	Lehighton	PA	Active
DSH390133DP	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 4S (06235) - Adults and Pediatrics (General Routine Care)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133DQ	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - HO ICU (02012) - Intensive Care Unit	3780 Hecktown Road	Easton	PA	Active
DSH390133E	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 PACU (02443)	1627 W. Chew Street, 2nd Floor	Allentown	PA	Active
DSH390133F	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 SSU/Observation (02102)	1627 W Chew Street, 3rd Floor	Allentown	PA	Active
DSH390133G	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 ED (02500)	1627 W Chew Street, Ground Floor	Allentown	PA	Active
DSH390133H	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 Heart Station/Vascular Lab (02412)	1627 West Chew Street	Allentown	PA	Terminated
DSH390133J	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - 17 CDC (02127)	1627 West Chew Street, 1st Floor	Allentown	PA	Terminated
DSH390133K	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 2S (18609, 10003007)	2545 SCHOENERSVILLE ROAD	Bethlehem	PA	Active
DSH390133L	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 2SEAU(10003008, 18608)	2545 Schoenersville Road	Bethlehem	PA	Terminated
DSH390133M	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 4T (18620)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133N	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 5T (18610)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133P	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 6T	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133Q	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M 7T (18619)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133R	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M ASU (18661)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133S	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Cardiac Cath (18723)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133T	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M CT SCAN (18722)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133U	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M CVM (18730)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133V	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Dental Clinic (18795)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133W	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M ED (18683)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133X	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Heart Station (18711)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133Y	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M ICU (18640)	2545 Schoenersville Road	Bethlehem	PA	Active
DSH390133Z	Child	DSH	LEHIGH VALLEY	Lehigh Valley Hospital - M Interventional RAD (18724)	2545 Schoenersville Road	Bethlehem	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Marchozzi, Thomas Executive Vice President & Chief Financial Officer Lehigh Valley Health Network 4848623943	Thomas, Robert Sr. Vice President Finance & Chief Accounting Officer Lehigh Valley Health Network 4848840901	2/7/2025 2:00 PM
Details	Last Recertification Date	Update	Recertification	8/31/2023 7:31:23 AM	8/29/2024 2:47:49 PM	8/29/2024 2:47 PM
Details	Last Recertification Date	Update	Recertification		8/31/2023 7:31:23 AM	8/31/2023 7:31 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 11:39 AM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Contacts	Signed By	Insert	New Registration		Marchozzi, Thomas Executive Vice President & Chief Financial Officer Lehigh Valley Health Network 4848623943	11/18/2022 8:15 AM
Details	340B ID	Update	New Registration		DSH390133G	11/18/2022 8:15 AM
Details	Entity Subname	Update	New Registration	Lehigh Valley Hospital	Lehigh Valley Hospital - 17 ED (02500)	11/18/2022 8:15 AM
Dates	Participating Approval Date	Update	New Registration		11/18/2022 8:15:18 AM	11/18/2022 8:15 AM
Details	State	Update	New Registration	Pending	Approved	11/18/2022 8:15 AM
Dates	Signed By Date	Update	New Registration		10/12/2022 7:09:37 AM	11/18/2022 8:15 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	11/18/2022 8:15 AM
Addresses	Main Address	Insert	New Registration		1627 W Chew Street, Ground Floor Allentown, PA 18102	10/6/2022 11:56 AM
Addresses	Billing Address	Insert	New Registration		Lehigh Valley Hospital 2100 Mack Boulevard Allentown, PA 18103	10/6/2022 11:56 AM
Addresses	Shipping Address	Insert	New Registration		Lehigh Valley Hospital 1627 Chew Street Allentown, PA 18102	10/6/2022 11:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/6/2022 11:56 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007660210023	10/6/2022 11:56 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/6/2022 11:56 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1164400131	10/6/2022 11:56 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/6/2022 11:56 AM
Contacts	Authorizing Official	Insert	New Registration		Marchozzi, Thomas Executive Vice President & Chief Financial Officer Lehigh Valley Health Network 4848623943	10/6/2022 11:56 AM
Contacts	Primary Contact	Insert	New Registration		Parnell, Claude Laurence 340B Program Manager Lehigh Valley Health Network 6104025522	10/6/2022 11:56 AM
Details	Assistance Received From Date	Insert	New Registration			10/6/2022 11:56 AM
Details	Assistance Received To Date	Insert	New Registration			10/6/2022 11:56 AM
Details	Last Recertification Date	Insert	New Registration			10/6/2022 11:56 AM
Details	Grant Number	Insert	New Registration			10/6/2022 11:56 AM
Details	340B ID	Insert	New Registration			10/6/2022 11:56 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/6/2022 11:56 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/6/2022 11:56 AM
Details	Medicare Provider Number	Insert	New Registration		390133	10/6/2022 11:56 AM
Details	Entity Name	Insert	New Registration		LEHIGH VALLEY	10/6/2022 11:56 AM
Details	NOFO Number	Insert	New Registration			10/6/2022 11:56 AM
Details	Program Code	Insert	New Registration		DSH	10/6/2022 11:56 AM
Details	Entity Subname	Insert	New Registration		Lehigh Valley Hospital	10/6/2022 11:56 AM
Dates	Participating Approval Date	Insert	New Registration			10/6/2022 11:56 AM
Details	State	Insert	New Registration		Pending	10/6/2022 11:56 AM
Dates	Registration Date	Insert	New Registration		10/6/2022 11:56:21 AM	10/6/2022 11:56 AM
Dates	Signed By Date	Insert	New Registration			10/6/2022 11:56 AM
Dates	Start Date	Insert	New Registration			10/6/2022 11:56 AM
Terminations	Termination Comments	Insert	New Registration			10/6/2022 11:56 AM
Terminations	Termination Date	Insert	New Registration			10/6/2022 11:56 AM
Terminations	Termination Effective Date	Insert	New Registration			10/6/2022 11:56 AM
Terminations	Termination Reason	Insert	New Registration			10/6/2022 11:56 AM