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DSH390185V LEHIGH VALLEY HOSPITAL-HAZLETON (Terminated)
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Main Details
Name
LEHIGH VALLEY HOSPITAL-HAZLETON
Subdivision Name
Industrial Medicine - Ind Med Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390185V
Medicare Provider Number
390185
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2021
Participating Start Date
4/1/2021
Participating Approval Date
2/12/2021
Last Recertification Date
8/25/2022
Termination Date
Termination Reason
10/1/2023
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
Lehigh Valley Health Network
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Primary Contact
Lehigh Valley Hospital
Paul Mattern, 340B Program Manager
(610) 402-1007
Addresses
Street Address
50 Moisey Drive
Hazleton, PA 18201
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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Participated starting 4/1/2019, terminated 4/1/2020. Reinstated 4/1/2021.
02/10/2021
June 2025
June 2025
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