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DSH390009G SAINT VINCENT HEALTH CENTER (Terminated)
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Main Details
Name
SAINT VINCENT HEALTH CENTER
Subdivision Name
Saint Vincent Imaging Center - West Side - RADIOLOGY/XRAY - RADIOLOGY/XRAY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390009G
Medicare Provider Number
390009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/22/2020
Last Recertification Date
8/17/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
SAINT VINCENT HEALTH CENTER
RANDOLPH LEVIS, CFO
(814) 452-5132
Primary Contact
AHN Saint Vincent
Stephen James Henderson, Pharmacist
(814) 452-5443
Addresses
Street Address
4247 WEST RIDGE ROAD
STE 103
Erie, PA 16506-1746
Billing Address
SAINT VINCENT HEALTH CENTER
232 WEST 25th STREET
Erie, PA 16544-0002
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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