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S H PHARMACY
DSH390049 ST. LUKES HOSPITAL
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Covered Entity Details
Entity Name
ST. LUKES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390049
Entity Address
801 OSTRUM STREET
BETHLEHEM, PA 18015
Medicare Provider Number
390049
Participating Start Date
1/1/2022
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
S H PHARMACY
Pharmacy Address
451 CHEW ST STE 201
ALLENTOWN, PA 18102
Pharmacy Comments
Contract Details
Approval Date
4/18/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Elizabeth Artis, Finance Director
(484) 526-4707
Contract Pharmacy Representative
Homestar
Joseph Borgioni, Administrator
(484) 526-7650
Signed By Date
4/18/2023
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