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S H PHARMACY
DSH390197 SACRED HEART HOSPITAL
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Covered Entity Details
Entity Name
SACRED HEART HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390197
Entity Address
421 CHEW STREET
ALLENTOWN, PA 18102
Medicare Provider Number
390197
Participating Start Date
7/1/2008
Last Recertification Date
9/10/2020
Entity Termination Date
2/2/2021
Pharmacy Details
Pharmacy Name
S H PHARMACY
Pharmacy Address
451 CHEW ST STE 201
ALLENTOWN, PA 18102
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/2/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Steve Lanshe, Vice president and Chief Legal Council
(610) 776-4502
Contract Pharmacy Representative
Homestar
Joseph Borgioni, Administrator
(484) 526-7650
Signed By Date
7/10/2019
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