340B Drug Pricing Program Database
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DSH390142A ALBERT EINSTEIN MEDICAL CENTER (Active)
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Main Details
Name
ALBERT EINSTEIN MEDICAL CENTER
Subdivision Name
ALBERT EINSTEIN CANCER CENTER @ CENTER ONE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390142A
Medicare Provider Number
390142
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
8/21/2006
Participating Start Date
10/1/2006
Participating Approval Date
8/23/2006
Last Recertification Date
8/26/2024
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
9880 Bustleton Avenue
Suite 332
Philadelphia, PA 19115
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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