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DSH390030Q Schuylkill Medical Center - South Jackson Street (Terminated)
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Main Details
Name
Schuylkill Medical Center - South Jackson Street
Subdivision Name
EAST NORWEGIAN STREET - Bacteriology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390030Q
Medicare Provider Number
390030
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/8/2018
Last Recertification Date
8/27/2019
Termination Date
Termination Reason
1/1/2020
Hospital Outpatient facility no longer eligible
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
700 East Norwegian Street
POTTSVILLE, PA 17901
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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