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DSH390223AJ PENN PRESBYTERIAN MEDICAL CENTER (Active)
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Main Details
Name
PENN PRESBYTERIAN MEDICAL CENTER
Subdivision Name
PMUC-PDLH 11th Floor - PMUC-PDLH 11th Floor ENDO PROC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390223AJ
Medicare Provider Number
390223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/24/2024
Last Recertification Date
Contacts
Authorizing Official
Penn Presbyterian Medical Center
Gene Gofman, Chief Financial Officer
(215) 662-9863
Primary Contact
Penn Presbyterian Medical Center
Nishaminy Kasbekar, Chief Pharmacy Officer
(215) 662-8213
Addresses
Street Address
3737 Market Street
11th Floor
Philadelphia, PA 19104
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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