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DSH390185AA LEHIGH VALLEY HOSPITAL-HAZLETON (Terminated)
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Main Details
Name
LEHIGH VALLEY HOSPITAL-HAZLETON
Subdivision Name
Laboratory - HWC Phlebotomy MT TOP
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390185AA
Medicare Provider Number
390185
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/4/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/31/2019
Last Recertification Date
8/20/2019
Termination Date
Termination Reason
1/1/2020
Other
Contacts
Authorizing Official
Lehigh Valley Health Network
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Primary Contact
Lehigh Valley Health Network
Claude Laurence Parnell, 340B Program Manager
(610) 402-5522
Addresses
Street Address
233. S. Mountain Boulevard
Mountain Top, PA 18707
Billing Address
Lehigh Valley Hospital - Hazleton
700 East Broad Street
Hazleton, PA 18201
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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