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DSH390009K SAINT VINCENT HEALTH CENTER (Active)
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Main Details
Name
SAINT VINCENT HEALTH CENTER
Subdivision Name
Imaging Center - PET CT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390009K
Medicare Provider Number
390009
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/19/2023
Last Recertification Date
8/27/2024
Contacts
Authorizing Official
SAINT VINCENT HEALTH CENTER
RANDOLPH LEVIS, CFO
(814) 452-5132
Primary Contact
SAINT VINCENT HEALTH CENTER
Rebecca Nick-Dart, Director of Pharmacy
(814) 452-5837
Addresses
Street Address
2508 MYRTLE ST
STE 100
ERIE, PA 16502
Billing Address
Saint Vincent Health Center
232 W. 25th St.
Erie, PA 16544
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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