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RRC390195-00 LANKENAU MEDICAL CENTER (Terminated)
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Main Details
Name
LANKENAU MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
Rural
No
340B ID
RRC390195-00
Medicare Provider Number
390195
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/24/2019
Last Recertification Date
8/31/2022
Termination Date
Termination Reason
4/1/2023
Change of covered entity type
Contacts
Authorizing Official
Lankenau Medical Center
Yonathan M Kebede, Vice President, Operations
(614) 323-9829
Primary Contact
Lankenau Medical Center
David K Showalter, System Director, Pharmacy Services
(484) 227-3611
Addresses
Street Address
100 LANCASTER AVE.
WYNNEWOOD, PA 19096
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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