340B Drug Pricing Program Database
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DSH390142L ALBERT EINSTEIN MEDICAL CENTER (Active)
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Main Details
Name
ALBERT EINSTEIN MEDICAL CENTER
Subdivision Name
RADIOLOGY CENTER ONE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390142L
Medicare Provider Number
390142
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2012
Participating Start Date
1/1/2013
Participating Approval Date
10/25/2012
Last Recertification Date
8/27/2024
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
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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