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DSH390226AD THE PENNSYLVANIA HOSPITAL (Terminated)
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Main Details
Name
THE PENNSYLVANIA HOSPITAL
Subdivision Name
334335 Rehab Med - Rehabilitation
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390226AD
Medicare Provider Number
390226
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/3/2020
Last Recertification Date
9/6/2023
Termination Date
Termination Reason
10/1/2024
Other
Contacts
Authorizing Official
Pennsylvania Hospital
Lindsay Ayling, CFO
(215) 713-4943
Primary Contact
Pennsylvania Hospital
Glen Bianchini, Director of Pharmacy Services
(215) 829-5847
Addresses
Street Address
801 Spruce Street
3rd Floor
Philadelphia, PA 19107
Billing Address
Pennsylvania Hospital
800 Spruce Street
Philadelphia, PA 19107
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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