340B Drug Pricing Program Database
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DSH390223AA PENN PRESBYTERIAN MEDICAL CENTER (Terminated)
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Main Details
Name
PENN PRESBYTERIAN MEDICAL CENTER
Subdivision Name
CRIP-MAPS / Pain Mgt
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390223AA
Medicare Provider Number
390223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/22/2017
Last Recertification Date
8/21/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Penn Presbyterian Medical Center
Gene Gofman, Chief Financial Officer
(215) 662-9863
Primary Contact
Penn Presbyterian Medical Center
Nishaminy Kasbekar, Director of Pharmacy
(215) 662-8213
Addresses
Street Address
51 N 39th Street
Suite 2c
Philadelphia, PA 19104
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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