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LEHIGH VALLEY PHARMACY SERVICES
DSH390201 POCONO MEDICAL CENTER
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Covered Entity Details
Entity Name
POCONO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390201
Entity Address
206 EAST BROWN STREET
EAST STROUDSBURG, PA 18301-3006
Medicare Provider Number
390201
Participating Start Date
3/15/2022
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
LEHIGH VALLEY PHARMACY SERVICES
Pharmacy Address
2024 LEHIGH ST STE 600
ALLENTOWN, PA 18103-4938
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Contract Pharmacy Representative
Health Spectrum Pharmacy Services (Specialty Pharmacy)
Sean G. Maydick, Pharmacist-in-Charge
(610) 402-2748
Signed By Date
4/9/2020
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