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LEHIGH VALLEY PHARMACY SERVICES
DSH390185 LEHIGH VALLEY HOSPITAL-HAZLETON
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Covered Entity Details
Entity Name
LEHIGH VALLEY HOSPITAL-HAZLETON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390185
Entity Address
700 EAST BROAD STREET
HAZLETON, PA 18201
Medicare Provider Number
390185
Participating Start Date
4/1/2019
Last Recertification Date
8/29/2024
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
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
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
4/11/2024
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