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DSH390226G THE PENNSYLVANIA HOSPITAL (Terminated)
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Main Details
Name
THE PENNSYLVANIA HOSPITAL
Subdivision Name
334339 PAH NEUROSURGERY-MAPS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390226G
Medicare Provider Number
390226
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/25/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/2/2018
Last Recertification Date
8/31/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
Pennsylvania Hospital
Frank Anastasi, Chief Financial Officer
(215) 829-8428
Primary Contact
Pennsylvania Hospital
Suzanne Y. Brown, Director of Pharmacy Services
(215) 829-5847
Addresses
Street Address
235 S. 8th St.
Washington Square West Building
Philadelphia, PA 19106
Billing Address
Pennsylvania Hospital
800 Spruce St.
Department of Pharmacy
Philadelphia, PA 19107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (5/14/2013), until terminated effective date (7/1/2015), reinstatement date effective: (April 01, 2018)
01/26/2018
June 2025
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