340B Drug Pricing Program Database
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DSH390133AW LEHIGH VALLEY (Active)
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Main Details
Name
LEHIGH VALLEY
Subdivision Name
Lehigh Valley Hospital - TL OR (02207)
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390133AW
Medicare Provider Number
390133
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/18/2022
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Lehigh Valley Health Network
Robert Thomas, Sr. Vice President Finance & Chief Accounting Officer
(484) 884-0901
Primary Contact
Lehigh Valley Hospital
Paul Mattern, 340B Program Manager
(610) 402-1007
Addresses
Street Address
4815 WEST TILGHMAN STREET
ALLENTOWN, PA 18104
Billing Address
Lehigh Valley Hospital
2100 Mack Boulevard
Allentown, PA 18103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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