340B Drug Pricing Program Database
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DSH390030C Schuylkill Medical Center - South Jackson Street (Terminated)
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Main Details
Name
Schuylkill Medical Center - South Jackson Street
Subdivision Name
SCHUYLKILL MEDICAL CENTER - SOUTH J - Womens Imaging
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390030C
Medicare Provider Number
390030
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/6/2018
Participating Start Date
10/1/2018
Participating Approval Date
9/5/2018
Last Recertification Date
8/27/2019
Termination Date
Termination Reason
4/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Lehigh Valley Health Network
Stephen Patrick Molitoris, Vice President
(484) 884-0974
Primary Contact
LVHN
Bernie Steven Koskulitz, Director Strategic Reimbursement
(570) 501-4933
Addresses
Street Address
171 RED HORSE RD STE 2
WOMEN'S IMAGING CENTER
POTTSVILLE, PA 17901-3625
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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