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DSH310086Y KENNEDY MEMORIAL HOSPITAL-UMC (Terminated)
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Main Details
Name
KENNEDY MEMORIAL HOSPITAL-UMC
Subdivision Name
Home Health care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310086Y
Medicare Provider Number
310086
Outpatient Facility Provider Number
317073
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/11/2016
Last Recertification Date
9/1/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
Contacts
Authorizing Official
Kennedy Memorial Hospital - UMC
Stephen V DeStefano, Vice President Finance
(215) 587-3332
Primary Contact
Thomas Jefferson University Hospital
Brian G. Swift, Chief Pharmacy Officer
(215) 955-6736
Addresses
Street Address
1099 White Horse Road
Voorhees, NJ 08043
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/11/16 CE reinstated effective 4/1/16, was participating from 10/1/15 to 12/31/15, not participating from 1/1/2016 to 3/31/16
03/11/2016
April 2025
April 2025
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