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DSH390223AC PENN PRESBYTERIAN MEDICAL CENTER (Active)
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Main Details
Name
PENN PRESBYTERIAN MEDICAL CENTER
Subdivision Name
Neurosurgery (PMUC) - Neurosurgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390223AC
Medicare Provider Number
390223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Penn Presbyterian Medical Center
Gene Gofman, Chief Financial Officer
(215) 662-9863
Primary Contact
Penn Presbyterian Medical Center
Justin Kuratnick, Director of Pharmacy
(215) 662-9291
Addresses
Street Address
3737 Market Street
7th and 8th Floor
Philadelphia, PA 19104-2640
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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