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DSH390076 BRANDYWINE HOSPITAL (Terminated)
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Main Details
Name
BRANDYWINE HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390076
Medicare Provider Number
390076
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/6/2020
Last Recertification Date
9/10/2021
Termination Date
Termination Reason
4/1/2022
Site closure
Contacts
Authorizing Official
Brandywine
michael francis szymanski, cfo
(610) 383-8009
Primary Contact
Brandywine Hospital
Lillian Mary Harasta, 340B Contract Manager
(610) 466-4594
Addresses
Street Address
201 REECEVILLE ROAD
COATSVILLE, PA 19320
Billing Address
BRANDYWINE HOSPITAL
201 Reeceville Road
Coatesville, PA 19320
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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