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RRC390195-01 LANKENAU MEDICAL CENTER (Terminated)
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Main Details
Name
LANKENAU MEDICAL CENTER
Subdivision Name
Main Line Health Center- Broomall - Radiology
Type
Rural Referral Center
Rural
No
340B ID
RRC390195-01
Medicare Provider Number
390195
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/25/2019
Last Recertification Date
8/24/2022
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
1991 Sproul Road
Broomall, PA 19008
Billing Address
Lankenau Medical Center
100 Lancaster Avenue
Attention Pharmacy Director
Wynnewood, PA 19096
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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