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DSH390174AF THOMAS JEFFERSON UNIVERSITY HOSPITAL (Terminated)
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Main Details
Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
MHD Urodynamics
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390174AF
Medicare Provider Number
390174
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/5/2014
Last Recertification Date
11/29/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
TJUH Inc
Andrew Nathans, Vice president Finance, TJUH Inc.
(215) 955-6599
Primary Contact
Thomas Jefferson University Hospital
Brian G. Swift, Chief Pharmacy Officer
(215) 955-6736
Addresses
Street Address
2301 South Broad Street
Philadelphia, PA 19148
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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