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DSH390080 JEANES HOSPITAL (Terminated)
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Main Details
Name
JEANES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390080
Medicare Provider Number
390080
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/12/2017
Last Recertification Date
8/19/2019
Termination Date
Termination Reason
4/1/2020
Other
Contacts
Authorizing Official
Jeanes Hospital
Ray Lefton, Chief Financial Officer, Treasurer
(215) 728-3306
Primary Contact
Jeanes Hospital
Denise Frasca, AHD Patient Service / CNO
(215) 728-2103
Addresses
Street Address
7600 CENTRAL AVENUE
PHILADELPHIA, PA 19111
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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