Covered Entity Details

DSH390163J ARMSTRONG COUNTY MEMORIAL (Active) - information as of 4/25/2025 9:21:20 PM

Main Details

Name

ARMSTRONG COUNTY MEMORIAL

Subdivision Name

ACMH RHEUMATOLOGY - Rheumatology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390163J

Medicare Provider Number

390163

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/6/2025

Participating Start Date

4/1/2025

Participating Approval Date

1/29/2025

Last Recertification Date

Contacts

Authorizing Official

Armstrong County Memorial Hospital
Matthew F Kociola, Chief Financial Officer
(724) 543-8618

Primary Contact

Armstrong County Memorial Hospital
Nathan Stolitza, Senior Accountant
(724) 543-8781

Addresses

Street Address

500 MEDICAL ARTS BLDG
STE 510
KITTANNING, PA 16201-7137

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH390163A	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - Leechburg PCC	116 MAIN STREET	LEECHBURG	PA	Active
DSH390163B	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - South Bethlehem PCC	102 SOUTH ST	NEW BETHLEHEM	PA	Active
DSH390163C	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - Endocrinology	600 MEDICAL ARTS BLDG, STE 640	KITTANNING	PA	Active
DSH390163D	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - Elderton PCC	116 MAIN STREET	ELDERTON	PA	Active
DSH390163E	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - Kittanning PCC	260 SOUTH JEFFERSON ST	KITTANNING	PA	Active
DSH390163F	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - Rural Valley PCC	10261 STATE ROUTE 85	KITTANNING	PA	Active
DSH390163G	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - West Hills PCC	300 MEDICAL ARTS BLDG	KITTANNING	PA	Active
DSH390163H	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ARMSTRONG COUNTY MEMORIAL HOSPITAL - Pulmonary	600 MEDICAL ARTS BLDG STE 670	KITTANNING	PA	Active
DSH390163J	Child	DSH	ARMSTRONG COUNTY MEMORIAL	ACMH RHEUMATOLOGY - Rheumatology	500 MEDICAL ARTS BLDG	KITTANNING	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	4/1/2025 12:01 AM
Contacts	Signed By	Insert	New Registration		Kociola, Matthew F Chief Financial Officer Armstrong County Memorial Hospital 7245438618	1/29/2025 1:53 PM
Details	340B ID	Update	New Registration		DSH390163J	1/29/2025 1:53 PM
Details	Entity Subname	Update	New Registration	ACMH RHEUMATOLOGY	ACMH RHEUMATOLOGY - Rheumatology	1/29/2025 1:53 PM
Dates	Participating Approval Date	Update	New Registration		1/29/2025 1:53:12 PM	1/29/2025 1:53 PM
Details	State	Update	New Registration	Pending	Approved	1/29/2025 1:53 PM
Dates	Signed By Date	Update	New Registration		1/6/2025 10:26:30 AM	1/29/2025 1:53 PM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	1/29/2025 1:53 PM
Addresses	Main Address	Insert	New Registration		500 MEDICAL ARTS BLDG STE 510 KITTANNING, PA 16201-7137	1/6/2025 9:41 AM
Contacts	Primary Contact	Insert	New Registration		Stolitza, Nathan Senior Accountant Armstrong County Memorial Hospital 7245438781	1/6/2025 9:41 AM
Contacts	Authorizing Official	Insert	New Registration		Kociola, Matthew F Chief Financial Officer Armstrong County Memorial Hospital 7245438618	1/6/2025 9:41 AM
Details	Assistance Received From Date	Insert	New Registration			1/6/2025 9:41 AM
Details	Assistance Received To Date	Insert	New Registration			1/6/2025 9:41 AM
Details	Last Recertification Date	Insert	New Registration			1/6/2025 9:41 AM
Details	Grant Number	Insert	New Registration			1/6/2025 9:41 AM
Details	340B ID	Insert	New Registration			1/6/2025 9:41 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/6/2025 9:41 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/6/2025 9:41 AM
Details	Medicare Provider Number	Insert	New Registration		390163	1/6/2025 9:41 AM
Details	Entity Name	Insert	New Registration		ARMSTRONG COUNTY MEMORIAL	1/6/2025 9:41 AM
Details	NOFO Number	Insert	New Registration			1/6/2025 9:41 AM
Details	Program Code	Insert	New Registration		DSH	1/6/2025 9:41 AM
Details	Entity Subname	Insert	New Registration		ACMH RHEUMATOLOGY	1/6/2025 9:41 AM
Dates	Participating Approval Date	Insert	New Registration			1/6/2025 9:41 AM
Details	State	Insert	New Registration		Pending	1/6/2025 9:41 AM
Dates	Registration Date	Insert	New Registration		1/6/2025 9:41:53 AM	1/6/2025 9:41 AM
Dates	Signed By Date	Insert	New Registration			1/6/2025 9:41 AM
Dates	Start Date	Insert	New Registration			1/6/2025 9:41 AM
Terminations	Termination Comments	Insert	New Registration			1/6/2025 9:41 AM
Terminations	Termination Date	Insert	New Registration			1/6/2025 9:41 AM
Terminations	Termination Effective Date	Insert	New Registration			1/6/2025 9:41 AM
Terminations	Termination Reason	Insert	New Registration			1/6/2025 9:41 AM