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DSH390256W PENN STATE - MILTON S. HERSHEY MEDICAL CENTER (Terminated)
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Main Details
Name
PENN STATE - MILTON S. HERSHEY MEDICAL CENTER
Subdivision Name
Cosmetic Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390256W
Medicare Provider Number
390256
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/13/2013
Last Recertification Date
11/15/2017
Termination Date
Termination Reason
10/1/2018
Change of covered entity type (non-hospital)
Contacts
Authorizing Official
Milton S. Hershey Medical Center
Eric Strucko, Interim Chief Financial Officer
(717) 531-6122
Primary Contact
Penn State Hershey Medical Center
Vincent Lacroce, Administrative Director of Pharmacy
(717) 531-6378
Addresses
Street Address
5 Capital Drive
STE 203
Harrisburg, PA 17110-9477
Billing Address
Penn State Milton S. Hershey Medical Center
500 University Dr
Hershey, PA 17033
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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