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DSH390226AY THE PENNSYLVANIA HOSPITAL (Approved)
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Main Details
Name
THE PENNSYLVANIA HOSPITAL
Subdivision Name
SPRUCE MRI - Radiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390226AY
Medicare Provider Number
390226
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/4/2025
Participating Start Date
7/1/2025
Participating Approval Date
5/2/2025
Last Recertification Date
Contacts
Authorizing Official
Pennsylvania Hospital
Lindsay Ayling, CFO
(215) 713-4943
Primary Contact
Pennsylvania Hospital
Glen Bianchini, Director of Pharmacy Services
(215) 829-5847
Addresses
Street Address
801 SPRUCE ST
PHILADELPHIA, PA 19107-5701
Billing Address
Pennsylvania Hospital
800 Spruce Street
Philadelphia, PA 19107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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