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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
9/17/2009
Contract Begin Date
9/17/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
PAUL MARINO, DIRECTOR OF PHARMACY
(610) 776-4828
Contract Pharmacy Representative
JOEL ALDERFER, DIRECTOR OF PHARMACY
(610) 776-0947
Signed By Date
9/9/2009
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