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DSH310086BR KENNEDY MEMORIAL HOSPITAL-UMC (Terminated)
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Main Details
Name
KENNEDY MEMORIAL HOSPITAL-UMC
Subdivision Name
KENNEDY UNIVERSITY HOSPITAL, INC - HB Clinic-Woodbury Surgery Bariatric
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH310086BR
Medicare Provider Number
310086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/17/2023
Participating Start Date
10/1/2023
Participating Approval Date
8/18/2023
Last Recertification Date
9/3/2024
Termination Date
Termination Reason
1/1/2025
DSH percentage below statutory minimum
Contacts
Authorizing Official
Kennedy Memorial Hospital - UMC
Stephen V DeStefano, Vice President Finance
(215) 587-3332
Primary Contact
Jefferson Health
Dustin Ottemiller, VP, Finance
(215) 503-5219
Addresses
Street Address
159 SOUTH BROAD STREET
JEFFERSON HEALTH WOODBURY PRIMARY & SPECIALTY CARE
WOODBURY, NJ 08096-2410
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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