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DSH310086Z KENNEDY MEMORIAL HOSPITAL-UMC (Terminated)
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Main Details
Name
KENNEDY MEMORIAL HOSPITAL-UMC
Subdivision Name
Kennedy Dialysis Center - Voorhees / CPD Dialysis Home Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310086Z
Medicare Provider Number
310086
Outpatient Facility Provider Number
313501
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
8/26/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Jefferson New Jersey
John W Graham, VP - Chief Administrative Officer
(856) 582-2661
Primary Contact
Kennedy University Hospital
Kenneth John Bevenour, Corporate Director, Pharmacy Services
(856) 346-7319
Addresses
Street Address
201 Laurel Oak 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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