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DSH390223H PENN PRESBYTERIAN MEDICAL CENTER (Active)
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Main Details
Name
PENN PRESBYTERIAN MEDICAL CENTER
Subdivision Name
Allergy and Immunology (PMUC)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390223H
Medicare Provider Number
390223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/7/2014
Participating Start Date
7/1/2014
Participating Approval Date
4/10/2014
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Penn Presbyterian Medical Center
Gene Gofman, Chief Financial Officer
(215) 662-9863
Primary Contact
Penn Presbyterian Medical Center
Justin Kuratnick, Director of Pharmacy
(215) 662-9291
Addresses
Street Address
3737 Market Street
3rd Floor
PHILADELPHIA, PA 19104
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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