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DSH390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL (Active)
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Main Details
Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390174
Medicare Provider Number
390174
Additional Details
Current Program Status
Active
Registration Date
3/1/2006
Participating Start Date
4/1/2006
Participating Approval Date
3/1/2006
Last Recertification Date
9/8/2024
Contacts
Authorizing Official
Jefferson Health
Walter Wyatt, VP-Finance
(215) 254-3254
Primary Contact
Jefferson Health
Dustin Ottemiller, VP, Finance
(215) 503-5219
Addresses
Street Address
111 South 11th Street
Philadelphia, PA 19107
Billing Address
Jefferson Center, Accounts Payable
1101 Market Street
20th Floor, Suite 2004
Philadelphia, PA 19107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/30/2014 - REMOVED SHIPPING ADDRESS NOW LISTED AS CONTRACT PHARMACY, SEE HISTORY FOR DETAILS; 8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; PART 1/1/97 TO 9/30/99 AS DSH19107, TERMINATED 10/1/99, REINSTATED 4/1/06
10/30/2014
8/28/09 - DOC RECD TO CONFIRM ELIG DSH ADJ %; PART 1/1/97 TO 9/30/99 AS DSH19107, TERMINATED 10/1/99, REINSTATED 4/1/06
10/20/2009
May 2025
May 2025
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