Covered Entity Details

DSH390056K JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON) (Active) - information as of 5/12/2025 10:03:17 PM

Main Details

Name

JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)

Subdivision Name

Penn Highlands ENT Tyrone - Ear, Nose & Throat

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390056K

Medicare Provider Number

390056

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/6/2025

Participating Start Date

4/1/2025

Participating Approval Date

2/12/2025

Last Recertification Date

Contacts

Authorizing Official

Penn Highlands Healthcare
Mark Norman, COO
(814) 375-6608

Primary Contact

Penn Highlands Healthcare
Mike Pasternak, 340B Compliance Manager
(814) 375-6139

Addresses

Street Address

417 Sabbath Road
Suite 3
Tyrone, PA 16686

Billing Address

Penn Highlands Huntingdon
1225 Warm Springs Ave.
Huntingdon, PA 16652

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?
Yes

State	Medicaid Number	NPI Number
PA	1007683760076	1700878840

Shipping Addresses

Shipping Address 1

Penn Highlands ENT Tyrone
417 Sabbath Rd
Suite 3
Tyrone, PA 16686

Shipping Address 2

Penn Highlands Huntingdon
1225 Warm Springs Ave.
Huntingdon, PA 16652

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
DSH390056A	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	JCB Specialty Care Center	1227 Warm Springs Ave.	Huntingdon	PA	Active
DSH390056B	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	JCB Gastroenterology - Gastroenterology	900 Bryan St	Huntingdon	PA	Active
DSH390056C	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	Family Medicine - Family Medicine	1227 Warm Springs Ave.	Huntingdon	PA	Active
DSH390056D	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	JCB Palliative Care - Palliative Care	1227 Warm Springs Ave.	Huntingdon	PA	Terminated
DSH390056E	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	JCB Surgical Center - Surgical Care Office	820 Bryan St	Huntingdon	PA	Active
DSH390056F	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	JCB Orthopedics - Orthopedics	1227 Warm Springs Ave.	Huntingdon	PA	Active
DSH390056G	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH Family Med/QCare State College - Family Med/Walk In Clinic	239 COLONNADE BLVD	State College	PA	Active
DSH390056H	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH CT Scan State College - CT Scanning	239 COLONNADE BLVD	STATE COLLEGE	PA	Active
DSH390056J	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH Family Medicine Pinecroft - Family Medicine	417 Sabbath Rest Road	Altoona	PA	Active
DSH390056K	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	Penn Highlands ENT Tyrone - Ear, Nose & Throat	417 Sabbath Road	Tyrone	PA	Active
DSH390056L	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH MRI Scan State College - MRI Scans	239 COLONNADE BLVD	STATE COLLEGE	PA	Active
DSH390056M	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH ONCOLGY/INFUSION STATE COLLEGE - ONCOLOGY/INFUSION SERVICES	239 COLONNADE BLVD	STATE COLLEGE	PA	Active
DSH390056N	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH Lung Center State College - Respiratory Disease	239 COLONNADE BLVD	State College	PA	Active
DSH390056P	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH Family Med/QCare Huntingdon - Family Med/Walk In Clinic	7651 Lake Raystown Shopping Center	Huntingdon	PA	Active
DSH390056Q	Child	DSH	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	PH Radiology State College - Radiology	239 COLONNADE BLVD	STATE COLLEGE	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		Norman, Mark COO Penn Highlands Healthcare 8143756608	2/12/2025 7:16 AM
Details	340B ID	Update	New Registration		DSH390056K	2/12/2025 7:16 AM
Details	Entity Name	Update	New Registration	PENN HIGHLANDS HUNTINGDON	JC BLAIR MEMORIAL HOSPITAL (dba PENN HIGHLANDS HUNTINGDON)	2/12/2025 7:16 AM
Details	Entity Subname	Update	New Registration	Penn Highlands ENT Tyrone	Penn Highlands ENT Tyrone - Ear, Nose & Throat	2/12/2025 7:16 AM
Dates	Participating Approval Date	Update	New Registration		2/12/2025 7:16:56 AM	2/12/2025 7:16 AM
Details	State	Update	New Registration	Pending	Approved	2/12/2025 7:16 AM
Dates	Signed By Date	Update	New Registration		1/6/2025 10:29:21 AM	2/12/2025 7:16 AM
Dates	Start Date	Update	New Registration		4/1/2025 12:00:00 AM	2/12/2025 7:16 AM
Addresses	Main Address	Insert	New Registration		417 Sabbath Road Suite 3 Tyrone, PA 16686	1/6/2025 10:19 AM
Addresses	Billing Address	Insert	New Registration		Penn Highlands Huntingdon 1225 Warm Springs Ave. Huntingdon, PA 16652	1/6/2025 10:19 AM
Addresses	Shipping Address	Insert	New Registration		Penn Highlands ENT Tyrone 417 Sabbath Rd Suite 3 Tyrone, PA 16686	1/6/2025 10:19 AM
Addresses	Shipping Address	Insert	New Registration		Penn Highlands Huntingdon 1225 Warm Springs Ave. Huntingdon, PA 16652	1/6/2025 10:19 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/6/2025 10:19 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007683760076	1/6/2025 10:19 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/6/2025 10:19 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1700878840	1/6/2025 10:19 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	1/6/2025 10:19 AM
Contacts	Primary Contact	Insert	New Registration		Pasternak, Mike 340B Compliance Manager Penn Highlands Healthcare 8143756139	1/6/2025 10:19 AM
Contacts	Authorizing Official	Insert	New Registration		Norman, Mark COO Penn Highlands Healthcare 8143756608	1/6/2025 10:19 AM
Details	Assistance Received From Date	Insert	New Registration			1/6/2025 10:19 AM
Details	Assistance Received To Date	Insert	New Registration			1/6/2025 10:19 AM
Details	Last Recertification Date	Insert	New Registration			1/6/2025 10:19 AM
Details	Grant Number	Insert	New Registration			1/6/2025 10:19 AM
Details	340B ID	Insert	New Registration			1/6/2025 10:19 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/6/2025 10:19 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/6/2025 10:19 AM
Details	Medicare Provider Number	Insert	New Registration		390056	1/6/2025 10:19 AM
Details	Entity Name	Insert	New Registration		PENN HIGHLANDS HUNTINGDON	1/6/2025 10:19 AM
Details	NOFO Number	Insert	New Registration			1/6/2025 10:19 AM
Details	Program Code	Insert	New Registration		DSH	1/6/2025 10:19 AM
Details	Entity Subname	Insert	New Registration		Penn Highlands ENT Tyrone	1/6/2025 10:19 AM
Dates	Participating Approval Date	Insert	New Registration			1/6/2025 10:19 AM
Details	State	Insert	New Registration		Pending	1/6/2025 10:19 AM
Dates	Registration Date	Insert	New Registration		1/6/2025 10:19:09 AM	1/6/2025 10:19 AM
Dates	Signed By Date	Insert	New Registration			1/6/2025 10:19 AM
Dates	Start Date	Insert	New Registration			1/6/2025 10:19 AM
Terminations	Termination Comments	Insert	New Registration			1/6/2025 10:19 AM
Terminations	Termination Date	Insert	New Registration			1/6/2025 10:19 AM
Terminations	Termination Effective Date	Insert	New Registration			1/6/2025 10:19 AM
Terminations	Termination Reason	Insert	New Registration			1/6/2025 10:19 AM