Covered Entity Details

DSH390086 DUBOIS REGIONAL MEDICAL CENTER (Active) - information as of 5/14/2025 10:49:25 PM

Main Details

Name

DUBOIS REGIONAL MEDICAL CENTER

Subdivision Name

dba Penn Highlands DuBois

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390086

Medicare Provider Number

390086

Additional Details

Current Program Status

Active

Registration Date

4/23/2008

Participating Start Date

7/1/2004

Participating Approval Date

4/23/2008

Last Recertification Date

8/12/2024

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

100 HOSPITAL AVENUE
DUBOIS, PA 15801

Billing Address

DuBois Regional Medical Center dba Penn Highlands DuBois
100 Hospital Ave
PO Box 447
DuBois, PA 15801

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	1007740880070,1007740880266,1007740880273,1007740880274,1007740880277,1007740880288,1007740880289,1007740880209,1007740880298	1144249657,1336517648,1578679981,1912038159,1871512855,1316537228,1053992966,1417555616,1063089415,1295729838,1275527814,1710995071,1124139365,1366900458,1992565121

Shipping Addresses

Shipping Address 1

Penn Highlands Community Pharmacy
621 S Main St
DuBois, PA 15801

Shipping Address 2

DuBois Regional Medical Center
100 Hospital Ave
DuBois, PA 15801

Shipping Address 3

DuBois Regional Medical Center
635 Maple Ave
Maple Division Pharmacy
DuBois, PA 15801

Shipping Address 4

McCabe Drug
419 Main St
Reynoldsville, PA 15851

Shipping Address 5

Penn Highlands Community Pharmacy Clarion
265 Holiday Inn Drive Route 68
Clarion, PA 16214

Shipping Address 6

Penn Highlands Clearfield
809 Turnpike Avenue
Inpatient Pharmacy
Clearfield, PA 16830

Shipping Address 7

Penn Highlands Community Pharmacy Punxsutawney
21911 Route 119
Punxsutawney, PA 15767

Shipping Address 8

St Marys Pharmacy
4 Railroad St
St Marys, PA 15857

Shipping Address 9

Bennetts Valley Pharmacy
18496 Bennetts Valley Hwy
Weedville, PA 15868

Shipping Address 10

Means Lauf Super Drug
265 Allegheny Boulevard
Brookville, PA 15825

Shipping Address 11

Brockway Drug Co.
1365 Main Street
Brockway, PA 15824

Shipping Address 12

Penn Highlands Community Pharmacy Ridgway
250 W Main Street
Ridgway, PA 15853

Shipping Address 13

Penn Highlands Specialty Pharmacy
720 S Main St.
DuBois, PA 15801

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	04/05/2018	07/01/2018		04/05/2018
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	04/05/2018	07/01/2018		04/05/2018
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	04/06/2018	07/01/2018		04/06/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	04/05/2018	07/01/2018	06/01/2023	06/07/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	04/06/2018	07/01/2018		04/06/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	04/06/2018	07/01/2018		04/06/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	01/04/2022	04/01/2022		04/01/2022
Contract Detail	BENNETT'S VALLEY PHARMACY INC	18496 BENNETTS VALLEY HWY	P.O. BOX 132	WEEDVILLE	PA	15868	12/05/2011	12/05/2011	05/01/2022	05/24/2022
Contract Detail	BIOLOGICS	BIOLOGICS BY MCKESSON	13000 WESTON PKWY, STE 105	CARY	NC	27513-2250	01/10/2020	04/01/2020	07/07/2020	07/15/2020
Contract Detail	BIOLOGICS, INC.	BIOLOGICS BY MCKESSON	11800 WESTON PARKWAY	CARY	NC	27513	07/07/2020	07/07/2020		07/13/2020
Contract Detail	BROCKWAY DRUG COMPANY INC	1365 MAIN STREET		BROCKWAY	PA	15824	07/03/2013	10/01/2013	10/01/2022	10/26/2022
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	04/03/2017	07/01/2017		04/26/2017
Contract Detail	CENTERWELL PHARMACY, INC.	9843 WINDISCH RD		WEST CHESTER	OH	45069	01/08/2021	04/01/2021	04/01/2024	04/01/2024
Contract Detail	CENTERWELL PHARMACY, INC.	10737 MARKS WAY		MIRAMAR	FL	33025	01/08/2021	04/01/2021	04/01/2024	04/01/2024
Contract Detail	CHARTWELL PENNSYLVANIA	1001 OAKDALE RD		OAKDALE	PA	15071-1502	04/17/2017	07/01/2017		04/26/2017
Contract Detail	CITY DRUGS OF CURWENSVILLE	360 THOMPSON ST		CURWENSVILLE	PA	16833	11/07/2011	11/10/2011		04/26/2017
Contract Detail	CLEARFIELD PHARMACY	307 E MARKET ST		CLEARFIELD	PA	16830-2432	07/03/2013	10/01/2013	06/26/2021	07/15/2021
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	04/03/2020	07/01/2020		07/01/2020
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	04/03/2020	07/01/2020		07/01/2020
Contract Detail	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	04/18/2016	07/01/2016	08/09/2017	08/09/2017
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	06/28/2017	07/01/2017		06/28/2017
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	04/10/2020	07/01/2020	04/21/2022	04/21/2022
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	04/11/2018	07/01/2018		04/11/2018
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	04/11/2018	07/01/2018		04/11/2018
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	255 PHILLIPI ROAD	COLUMBUS	OH	43228	04/11/2018	07/01/2018	07/18/2018	07/23/2018
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	04/11/2018	07/01/2018		04/11/2018
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	04/11/2018	07/01/2018		04/11/2018
Contract Detail	GIANT EAGLE PHARMACY #0080	40 WHITE STREET		BROOKVILLE	PA	15825	10/16/2014	01/01/2015		04/26/2017
Contract Detail	GIANT EAGLE PHARMACY #0084	100 N. MAIN STREET		DUBOIS	PA	15801-1888	10/16/2014	01/01/2015		04/26/2017
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	10/12/2021	01/01/2022		01/01/2022
Contract Detail	MARIENVILLE PHARMACY	120 CHERRY ST	PO BOX 434	MARIENVILLE	PA	16239	10/10/2018	01/01/2019		01/01/2019
Contract Detail	MCCABE DRUG, LLC	419 MAIN STREET		REYNOLDSVILLE	PA	15851	01/11/2017	04/01/2017	09/28/2017	09/28/2017
Contract Detail	MEANS & LAUF SUPER DRUG		155 MAIN STREET	BROOKVILLE	PA	15825	09/30/2011	10/05/2011	08/19/2015	04/26/2017
Contract Detail	MEANS LAUF SUPER DRUG	265 ALLEGHENY BLVD		BROOKVILLE	PA	15825-2321	05/01/2015	05/08/2015	08/01/2022	10/18/2022
Contract Detail	MOSHANNON VALLEY PHARMACY INC	208 MEDICAL CENTER DR		PHILIPSBURG	PA	16866	01/06/2015	04/01/2015		04/26/2017
Contract Detail	ONCOMED PHARMACEUTICAL SERVICES OF MA, L	D/B/A ONCO360	335 BEAR HILL RD STE 2100	WALTHAM	MA	02451	01/15/2019	04/01/2019	05/18/2020	05/18/2020
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	01/15/2019	04/01/2019	05/18/2020	05/29/2020
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/04/2022	01/13/2022		01/13/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/10/2020	07/01/2020		07/01/2020
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	07/12/2021	07/16/2021		07/16/2021
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	04/10/2020	07/01/2020		07/01/2020
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01685	3035 PARK PLACE	CLEARFIELD	PA	16830	01/15/2015	04/01/2015		04/26/2017
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01686	236 GRANT STREET	JOHNSONBURG	PA	15845	01/15/2015	04/01/2015		04/26/2017
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05709	405 W DUBOIS AVE	DUBOIS	PA	15801	01/15/2015	04/01/2015		04/26/2017
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01680	700 MAIN STREET	CLARION	PA	16214	07/06/2016	10/01/2016		04/26/2017
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01919	815 N. FRONT ST.	PHILIPSBURG	PA	16866	07/06/2016	10/01/2016		04/26/2017
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/10/2017	10/01/2017	10/10/2022	10/26/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/03/2017	07/01/2017		04/26/2017
Contract Detail	PUNXSY HOMETOWN PHARMACY, LLC	PUNXSY HOMETOWN PHARMACY	GROUNDHOG PLAZA 203 NORTH HAMPTON AVENUE	PUNXSUTAWNEY	PA	15767-1576	04/09/2013	07/01/2013	12/31/2020	01/11/2021
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #740	8878 CLEARFIELD CURWENSVILLE HWY	CLEARFIELD	PA	16830	10/16/2013	01/01/2014	06/27/2021	07/15/2021
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2476	101 MAIN STREET	RIDGWAY	PA	15853	10/16/2013	01/01/2014		04/26/2017
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #7850	620 E ALLEGHENY AVENUE	EMPORIUM	PA	15834	10/16/2013	01/01/2014	01/29/2021	01/29/2021
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #7853	901 S SAINT MARYS STREET	SAINT MARYS	PA	15857	10/16/2013	01/01/2014		04/26/2017
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #6739	1365 LOGAN AVENUE	TYRONE	PA	16686	01/15/2021	04/01/2021		04/01/2021
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #6740	3106 E PLEASANT VALLEY	ALTOONA	PA	16601	01/15/2021	04/01/2021		04/01/2021
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #7850	620 E ALLEGHENY AVENUE	EMPORIUM	PA	15834	03/25/2021	03/25/2021		03/25/2021
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID PHARMACY #6839	307 E MARKET ST	CLEARFIELD	PA	16830-2432	07/15/2021	07/16/2021		07/16/2021
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	07/15/2021	10/01/2021		10/01/2021
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	01/15/2019	04/01/2019		04/01/2019
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	01/15/2019	04/01/2019		04/01/2019
Contract Detail	SORKIN'S RX LTD	D/B/A CAREMED PHARMACEUTICAL SERVICES	1985 MARCUS AVE STE 130	NEW HYDE PARK	NY	11042-2024	01/15/2019	04/01/2019		04/01/2019
Contract Detail	St. Mary's Pharmacy	4 Railroad Street		St. Marys	PA	15857	12/15/2011	12/15/2011	05/01/2022	05/24/2022
Contract Detail	THE MEDICINE SHOPPE	301 W MAIN ST	SUITE 3	BROOKVILLE	PA	15825	09/30/2011	10/05/2011	10/01/2024	11/18/2024
Contract Detail	THE MEDICINE SHOPPE	30 W PARK AVE		DU BOIS	PA	15801-2452	09/30/2011	10/05/2011	03/07/2024	04/01/2024
Contract Detail	THE MEDICINE SHOPPE	1101 PARKWAY VIEW DR		PITTSBURGH	PA	15205	07/17/2018	10/01/2018	10/04/2024	11/18/2024
Contract Detail	THE MEDICINE SHOPPE	3913 HARTZDALE DR STE 1306		CAMP HILL	PA	17011-7845	07/17/2018	10/01/2018	10/04/2024	11/18/2024
Contract Detail	THE MEDICINE SHOPPE	730 WASHINGTON ST		HUNTINGDON	PA	16652	01/03/2020	04/01/2020	01/01/2023	01/17/2023
Contract Detail	THE PRESCRIPTION CENTER OF	THE PRESCRIPTION CENTER OF	RIDGWAY 223 MAIN ST	RIDGWAY	PA	15853-1015	10/16/2014	01/01/2015	04/01/2023	04/17/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10975	201 WEST MAHONING STREET	PUNXSUTAWNEY	PA	15767	10/16/2013	01/01/2014		04/26/2017
Contract Detail	THRIFT DRUG, INC.	RITE AID #10976	431 COMMONS DRIVE	DUBOIS	PA	15801	10/16/2013	01/01/2014		04/26/2017
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/02/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART PHARMACY 10-1769	20 INDUSTRIAL DRIVE		DU BOIS	PA	15801	01/18/2012	01/18/2012		04/26/2017
Contract Detail	WAL-MART PHARMACY 10-1792	1102 MILLION DOLLAR HIGHWAY		ST MARY'S	PA	15857	02/24/2012	02/24/2012		04/26/2017
Contract Detail	WAL-MART PHARMACY 10-2129	100 SUPERCENTER DR		CLEARFIELD	PA	16830	02/24/2012	02/24/2012		04/26/2017
Contract Detail	WAL-MART PHARMACY 10-2540	63 PERKINS ROAD		CLARION	PA	16214	04/15/2021	07/01/2021		07/01/2021
Contract Detail	WAL-MART PHARMACY 10-2664	21920 ROUTE #119		PUNXSUTAWNEY	PA	15767	02/24/2012	02/24/2012		04/26/2017
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/02/2019	01/01/2020		01/01/2020
Contract Detail	WAL-MART PHARMACY 10-5470	6716 TOWN CENTER BLVD		HUNTINGDON	PA	16652	07/15/2021	10/01/2021		10/01/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/02/2019	01/01/2020		01/01/2020
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/18/2016	07/01/2016	10/01/2021	11/14/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/18/2016	07/01/2016		04/26/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/18/2016	07/01/2016		04/26/2017
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/18/2016	07/01/2016		04/26/2017
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/17/2023	04/01/2023		04/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/17/2023	01/01/2024		01/01/2024
Contract Detail	WOODWARD PHARMACY	565 SPRING ST		HOUTZDALE	PA	16651-1756	01/06/2015	04/01/2015		04/26/2017

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH390086AC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery DuBois 90910	145 Hospital Avenue	DuBois	PA	Terminated
DSH390086AD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Perinatal Consultants 90800	869 Beaver Drive	DuBois	PA	Terminated
DSH390086AE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois	65 Developac Road	DuBois	PA	Active
DSH390086AF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Wound Center	635 Maple Ave	DuBois	PA	Active
DSH390086AK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology Brookville	88 Hospital Road	Brookville	PA	Active
DSH390086AL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology Clearfield	807 Turnpike Ave	Clearfield	PA	Active
DSH390086AM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Ridgway 94275	123 South Street	Ridgway	PA	Terminated
DSH390086AN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys	177 Washington Street	St Marys	PA	Active
DSH390086AR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine DuBois	145 Hospital Ave	DuBois	PA	Active
DSH390086AS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois	145 Hospital Avenue	DuBois	PA	Active
DSH390086AU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Infectious Disease 90660	635 Maple Ave	DuBois	PA	Terminated
DSH390086AW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine 94280	416 North Broad St	Emporium	PA	Terminated
DSH390086AX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology DuBois	145 Hospital Ave	DuBois	PA	Active
DSH390086AY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery DuBois	145 Hospital Ave	DuBois	PA	Active
DSH390086AZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology St Marys	1100 Million Dollar Highway	St Marys	PA	Terminated
DSH390086BA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology DuBois 90610	145 Hospital Ave	DuBois	PA	Active
DSH390086BB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurology St Marys	1100 Million Dollar Highway	St Marys	PA	Active
DSH390086BC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurology DuBois	123 Hospital Ave	DuBois	PA	Active
DSH390086BF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Behavioral Health DuBois 71110	635 Maple Avenue	DuBois	PA	Active
DSH390086BG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Behavioral Health St Marys 71110	1100 Million Dollar Highway	St Marys	PA	Terminated
DSH390086BH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Hyperbaric Oxygen Therapy 77420	635 Maple Avenue	DuBois	PA	Terminated
DSH390086BN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Fracture Clinic	123 Hospital Ave	DuBois	PA	Terminated
DSH390086BP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Integrated Primary Care 71130	100 Caldwell Drive	DuBois	PA	Terminated
DSH390086BQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Oncology/Hematology Clearfield 78760	815 Doctors Drive	Clearfield	PA	Active
DSH390086BR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center DuBois 78200	145 Hospital Ave	DuBois	PA	Active
DSH390086BS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center DuBois 90780	145 Hospital Ave	DuBois	PA	Active
DSH390086BT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine Ridgway 94271	99 Hospital Street	Ridgway	PA	Terminated
DSH390086BU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pulmonology and Sleep Medicine St Marys	1100 Million Dollar Highway	St Marys	PA	Active
DSH390086BY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Women's Care DuBois 90700	145 Hospital Avenue	DUBOIS	PA	Terminated
DSH390086BZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endoscopy Center	621 South Main Street	DUBOIS	PA	Terminated
DSH390086C	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois 90570	145 Hospital Avenue	DuBois	PA	Terminated
DSH390086CA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Cardiopulmonary	100 HOSPITAL AVE	DUBOIS	PA	Terminated
DSH390086CB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands DuBois Sleep Lab 75900	621 South Main Street	DUBOIS	PA	Active
DSH390086CC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90570	145 Hospital Ave	DUBOIS	PA	Terminated
DSH390086CD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology Philipsburg 90740	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086CE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center DuBois 90670	100 HOSPITAL AVE	DUBOIS	PA	Active
DSH390086CF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Clearfield 90670	815 Doctor's Drive	Clearfield	PA	Active
DSH390086CG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Brookville 90670	88 Hospital Road	Brookville	PA	Active
DSH390086CH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology Clearfield 93370	531 Hannah Street	Clearfield	PA	Terminated
DSH390086CJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology St Marys 93370	1095 Million Dollar Highway	St. Marys	PA	Terminated
DSH390086CK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Dermatology 90750	90 Beaver Drive	DUBOIS	PA	Terminated
DSH390086CL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Clearfield 93210	502 Park Avenue	Clearfield	PA	Terminated
DSH390086CM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois 90570	145 Hospital Ave	DuBois	PA	Terminated
DSH390086CN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Clearfield 93230	807 Turnpike Ave.	Clearfield	PA	Active
DSH390086CP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine / Q Care Ridgway 94180	250 W Main St.	Ridgway	PA	Active
DSH390086CQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Cameron County 94160	416 North Broad Street	Emporium	PA	Terminated
DSH390086CR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Ridgway 94130	104 Metoxet Street	Ridgway	PA	Terminated
DSH390086CS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care St Marys 94270	761 Johnsonburg Road	St. Marys	PA	Active
DSH390086CT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics Brookville 90720	2834 Maplevale Rd	Brookville	PA	Terminated
DSH390086CU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics St Marys 94310	761 Johnsonburg Rd	St Marys	PA	Terminated
DSH390086CV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics Midline 90720	135B Midline Drive	DuBois	PA	Terminated
DSH390086CW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics DuBois 90720	529 Sunflower Drive	DuBois	PA	Terminated
DSH390086CX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine Clearfield 93250	531B Hannah Street	Clearfield	PA	Terminated
DSH390086CY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics GRAH/MAR/SOR - Clearfield 93260	1033 Turnpike Avenue	Clearfield	PA	Active
DSH390086CZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Center Pediatrics Grah/Mar/Sor -Philipsburg 93260	1049 North Front Street	Philipsburg	PA	Terminated
DSH390086D	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Brookville 95550	240 Allegheny Blvd	Brookville	PA	Terminated
DSH390086DA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Clearfield	815 Doctor's Drive	Clearfield	PA	Active
DSH390086DB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Philipsburg 93290	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086DC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine Philipsburg	271 Railroad Street	Philipsburg	PA	Active
DSH390086DD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopaedics Clearfield 93310	807 Turnpike Avenue	Clearfield	PA	Terminated
DSH390086DE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology Clearfield 90835	807 Turnpike Avenue	Clearfield	PA	Active
DSH390086DF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Obstetrics Carnevale - Clearfield 93350	807 Turnpike Avenue	Clearfield	PA	Terminated
DSH390086DG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94140	1100 Million Dollar Highway	St. Marys	PA	Active
DSH390086DH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine St Marys 94190	761 Johnsonburg Road	St. Marys	PA	Active
DSH390086DJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Johnsonburg 94300	111-114 Cobb Street	Johnsonburg	PA	Terminated
DSH390086DK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St. Marys 94170	757 Johnsonburg Road	St. Marys	PA	Active
DSH390086DL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Emporium 94170	275 East Fourth Street	Emporium	PA	Terminated
DSH390086DM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94170	757 Johnsonburg Road	St. Marys	PA	Active
DSH390086DN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine St Marys 90760	761 Johnsonburg Road	St. Marys	PA	Active
DSH390086DP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands OB/GYN Koch/Batchev - 94230	761 Johnsonburg Road	St. Marys	PA	Terminated
DSH390086DQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94250	761 Johnsonburg Road	St. Marys	PA	Terminated
DSH390086DR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	POHE OB LIN - Women's Care 94290	761 Johnsonburg Road	St. Marys	PA	Terminated
DSH390086DS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Apnea/Reflux Clinic 78500	145 HOSPITAL AVE	DUBOIS	PA	Active
DSH390086DT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Punxsy 94120	551 W. Mahoning St.	Punxsutawney	PA	Terminated
DSH390086DU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Ridgway 94240	123 South Street	Ridgway	PA	Terminated
DSH390086DV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Punxsy 90890	104 West Mahoning Street	Punxsutawney	PA	Terminated
DSH390086DW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Breast Care Services	123 Hospital Ave	DuBois	PA	Active
DSH390086DX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery St Marys	761 Johnsonburg Rd	St Marys	PA	Active
DSH390086DY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands DuBois Surgery Center	95 Hoover Ave	DuBois	PA	Active
DSH390086DZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine-Donahue	145 Hospital Ave	DuBois	PA	Terminated
DSH390086E	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology Brookville 95570	240 Allegheny Blvd.	Brookville	PA	Terminated
DSH390086EA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Clearfield 90780	815 Doctors Drive	Clearfield	PA	Active
DSH390086EB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center St Marys	1100 Million Dollar Hwy	St Marys	PA	Active
DSH390086EC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Philipsburg 90610	271 Railroad St.	Philipsburg	PA	Active
DSH390086ED	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Punxsy 90610	21911 Route 119	Punxsutawney	PA	Terminated
DSH390086EE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center Philipsburg 78200	271 Railroad St.	Philipsburg	PA	Active
DSH390086EF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Philipsburg 90670	271 Railroad St.	Philipsburg	PA	Active
DSH390086EG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Punxsy 90670	21911 Route 119	Punxsutawney	PA	Active
DSH390086EH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center Punxsy 78200	21911 Route 119	Punxsutawney	PA	Terminated
DSH390086EJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois 90660	145 Hospital Ave.	DuBois	PA	Active
DSH390086EK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Clearfield 90610	807 Turnpike Ave	Clearfield	PA	Terminated
DSH390086EL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Philipsburg 90780	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086EM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care DuBois 90920	621 South Main Street	DuBois	PA	Active
DSH390086EN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Punxsutawney 90950	21911 Route 119	Punxsutawney	PA	Active
DSH390086EP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Sports Medicine 93390	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086EQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology Brookville 90630	88 Hospital Road	Brookville	PA	Terminated
DSH390086ER	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology Punxsy 90630	21911 Route 119	Punxsutawney	PA	Terminated
DSH390086ES	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology St Marys	1100 Million Dollar Highway	St Marys	PA	Active
DSH390086ET	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Clarion 90670	265 Holiday Inn Rd.	Clarion	PA	Active
DSH390086EU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center Clearfield 78200	809 Turnpike Ave	Clearfield	PA	Terminated
DSH390086EV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Brookville Rural Health Center 95020	22 Industrial Park Rd	Brookville	PA	Active
DSH390086EW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Punxsy 90940 - Family Medicine	551 W. Mahoning St	Punxsutawney	PA	Terminated
DSH390086EX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology St Marys	1100 Million Dollar Highway	St Marys	PA	Terminated
DSH390086EY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopaedics Philipsburg 93310	271 Railroad St	Philipsburg	PA	Terminated
DSH390086EZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Philipsburg 93280	271 Railroad St	Philipsburg	PA	Terminated
DSH390086FA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Residency Clinic 90570	145 Hospital Ave	DuBois	PA	Active
DSH390086FB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Brookville 95550	240 Allegheny Blvd.	Brookville	PA	Terminated
DSH390086FC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Punxsy 90640	551 W. Mahoning St.	Punxsutawney	PA	Terminated
DSH390086FD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Clarion 94120	1008 S 5th Ave.	Clarion	PA	Terminated
DSH390086FE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94180 - Family Medicine	1100 Million Dollar Hwy	St Marys	PA	Terminated
DSH390086FF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Brookville 90610 - Endocrinology	88 Hospital Road	Brookville	PA	Terminated
DSH390086FG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine Clearfield 90760	815 Doctors Drive	Clearfield	PA	Terminated
DSH390086FH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center St Marys 94330	761 Johnsonburg Rd	St Marys	PA	Active
DSH390086FJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Brookville 95590	111 Summit Street	Brookville	PA	Terminated
DSH390086FK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Clearfield 93420	1900 River Road	Clearfield	PA	Active
DSH390086FL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Brookville Diabetic Clinic 78200 - Diabetic Clinic	100 Hospital Road	Brookville	PA	Terminated
DSH390086FM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurosurgery DuBois	123 Hospital Ave	DuBois	PA	Active
DSH390086FN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurosurgery Clarion	265 Holiday Inn Road	Clarion	PA	Terminated
DSH390086FP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Huntingdon 90670 - Lung Center	820 Bryan Street	Huntingdon	PA	Terminated
DSH390086FQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Huntingdon 98010 - Family Medicine	820 Bryan Street	Huntingdon	PA	Terminated
DSH390086FR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Cardiovascular & Thoracic Surgery 90600 - Cardiovascular and Thoracic Surgery	145 Hospital Ave	DuBois	PA	Active
DSH390086FS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics Brookville - Orthopedics	88 Hospital Road	Brookville	PA	Terminated
DSH390086FT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Oncology/Hematology St. Marys - Oncology	1100 Million Dollar Highway	St. Marys	PA	Active
DSH390086FU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Oncology/Hematology Brookville - Oncology	88 Hospital Road	Brookville	PA	Active
DSH390086FV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Rheumatology	145 Hospital Ave	DuBois	PA	Active
DSH390086FW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurosurgery Huntingdon - Neurosurgery	820 Bryan Street	Huntingdon	PA	Terminated
DSH390086FX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Endocrinology - Clarion - Endocrinology	265 Holiday Inn Road	Clarion	PA	Terminated
DSH390086FY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Clearfield Campus Operating Room - Operating Room	809 Turnpike Avenue	Clearfield	PA	Active
DSH390086FZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Bright Horizons Behavioral Health Services - Clearfield - Psychiatric/Psychological services	1033 Turnpike Ave.	Clearfield	PA	Active
DSH390086GA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH Familiy Medicine - Hawkins - Family Medicine	761 Johnsonburg Road	Saint Marys	PA	Active
DSH390086GB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Cardiopulmonary - Clearfield - Cardiopulmonary	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Clearfield Radiology - Radiology	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology - Clarion - Gastroenterology	265 Holiday Inn Road	Clarion	PA	Active
DSH390086GE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Clearfield Campus Cardiac Rehabilitation - Cardiac Rehabilitation	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Clearfield Campus Recovery Room - Post Op Recovery Room	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Weight Management/Diabetic Clinic - St Marys - Weight Management/Diabetic Education	1100 Million Dollar Highway	Saint Marys	PA	Terminated
DSH390086GH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Orthopedics - Clarion - Orthopedics	265 Holiday Inn Road	Clarion	PA	Active
DSH390086GJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Emergency Department - Clearfield - Emergency Medicine	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Wound Clinic - Clearfield - Wound Care	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH FAM MED/QCARE CLARION - Family Medicine	265 HOLIDAY INN RD	CLARION	PA	Active
DSH390086GM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH PEDIATRICS DUBOIS - Pediatrics DuBois	123 HOSPITAL AVE	DU BOIS	PA	Active
DSH390086GN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine - PH Orthopedics and Sports Med DuBois COE	123 Hospital Ave	DuBois	PA	Active
DSH390086GP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Life's Journey - PH Life's Journey DuBois	123 Hospital Ave	DuBois	PA	Active
DSH390086GQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Integrated Recovery - Integrated Recovery DuBois	635 Maple Ave	DuBois	PA	Active
DSH390086GR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH Life's Journey - PH Life's Journey Punxsutawney	21911 Route 119	Punxsutawney	PA	Active
DSH390086GS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH MEDICAL ONCOLOGY PUNXSY - ONCOLOGY	21911 ROUTE 119	PUNXSUTAWNEY	PA	Active
DSH390086GT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH GASTROENTEROLOGY CLEARFIELD - Gastroenterology	807 Turnpike Ave.	Clearfield	PA	Active
DSH390086GU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH Life's Journey Clarion - OB/GYN	265 Holiday Inn Road	Clarion	PA	Active
DSH390086H	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Brookville 95510	90 Hospital Rd	Brookville	PA	Terminated
DSH390086L	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90500	100 Meadow Lane	DuBois	PA	Active
DSH390086M	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Rheumatology	621 South Main Street	DuBois	PA	Active
DSH390086N	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Infusion Therapy	621 South Main Street	DuBois	PA	Active
DSH390086P	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Reynoldsville 90560	5 North Third Street	Reynoldsville	PA	Active
DSH390086Q	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Cardiovascular/Thoracic Surgery 90600	145 Hospital Ave	DuBois	PA	Active
DSH390086R	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90530	100 Meadow Lane	DuBois	PA	Active
DSH390086S	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pulmonology and Sleep Medicine DuBois 90810	621 South Main St	DuBois	PA	Active
DSH390086T	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology DuBois 90740	529 Sunflower Drive	DuBois	PA	Active
DSH390086U	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology DuBois	621 South Main Street	DuBois	PA	Active
DSH390086V	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90540	145 Hospital Ave	DuBois	PA	Active
DSH390086W	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90520	145 Hospital Ave	DuBois	PA	Terminated
DSH390086X	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Force 90580	230 Hemlock Avenue	Force	PA	Terminated
DSH390086Y	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Brockway 90510	1200 Wood St	Brockway	PA	Active
DSH390086Z	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Curwensville 93340	465 State St	Curwensville	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Change Request		Penn Highlands Specialty Pharmacy 720 S Main St. DuBois, PA 15801	1/21/2025 7:24 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1992565121	1/21/2025 7:24 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	1/21/2025 7:24 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/10/2024 7:44 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007740880298	12/10/2024 7:44 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	12/10/2024 7:44 AM
Details	Last Recertification Date	Update	Recertification	8/15/2023 7:40:50 AM	8/12/2024 9:47:47 AM	8/12/2024 9:47 AM
Addresses	Shipping Address	Insert	Change Request		Penn Highlands Community Pharmacy Ridgway 250 W Main Street Ridgway, PA 15853	6/26/2024 8:31 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1366900458	6/25/2024 7:45 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	6/25/2024 7:45 AM
Contacts	Authorizing Official	Update	Change Request	Schneider, Heather B System CFO Penn Highlands Healthcare 8143756432	Norman, Mark COO Penn Highlands Healthcare 8143756608	5/2/2024 3:44 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/15/2023 7:40 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007740880289	8/15/2023 7:40 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/15/2023 7:40 AM
Details	Last Recertification Date	Update	Recertification	9/12/2022 4:06:59 PM	8/15/2023 7:40:50 AM	8/15/2023 7:40 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	7/10/2023 7:07 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007740880288	7/10/2023 7:07 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	7/10/2023 7:07 AM
Contacts	Primary Contact	Update	Group Change Request	Voelker, Bailey 340B Coordinator Penn Highlands Healthcare 8143756625	Pasternak, Mike 340B Compliance Manager Penn Highlands Healthcare 8143756139	3/31/2023 12:30 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/18/2023 7:23 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007740880277	1/18/2023 7:23 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/18/2023 7:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/16/2023 7:06 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007740880274	1/16/2023 7:06 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	1/16/2023 7:06 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/4/2022 7:16 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007740880273	11/4/2022 7:16 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/4/2022 7:16 AM
Addresses	Shipping Address	Insert	Change Request		Brockway Drug Co. 1365 Main Street Brockway, PA 15824	10/18/2022 11:05 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 7:46:37 AM	9/12/2022 4:06:59 PM	9/12/2022 4:06 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0295809 (OH)		5/24/2022 2:44 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1144249657 (CA)		5/24/2022 2:44 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003079565 (CT)		5/24/2022 2:44 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	902352600 (FL)		5/24/2022 2:44 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	003149125A (GA)		5/24/2022 2:44 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1700444 (LA)		5/24/2022 2:44 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	0485373 (NJ)		5/24/2022 2:44 PM
Contacts	Authorizing Official	Update	AO Change Request	Kline, Brian CFO Penn Highlands DuBois 8143756377	Schneider, Heather B System CFO Penn Highlands Healthcare 8143756432	5/11/2022 7:40 AM
Addresses	Shipping Address	Insert	Change Request		Means Lauf Super Drug 265 Allegheny Boulevard Brookville, PA 15825	5/6/2022 7:34 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1295729838	4/19/2022 7:55 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	4/19/2022 7:55 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1275527814	4/19/2022 7:55 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	4/19/2022 7:55 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1710995071	4/19/2022 7:55 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	4/19/2022 7:55 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1124139365	4/19/2022 7:55 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	4/19/2022 7:55 AM
Addresses	Shipping Address	Insert	Change Request		St Marys Pharmacy 4 Railroad St St Marys, PA 15857	12/20/2021 2:40 PM
Addresses	Shipping Address	Insert	Change Request		Bennetts Valley Pharmacy 18496 Bennetts Valley Hwy Weedville, PA 15868	12/20/2021 2:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	11/30/2021 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007740880266	11/30/2021 2:59 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	11/30/2021 2:59 PM
Addresses	Shipping Address	Update	Change Request	Penn Highlands Community Pharmacy Punxsutawney 21871 US-119 Punxsutawney, PA 15767	Penn Highlands Community Pharmacy Punxsutawney 21911 Route 119 Punxsutawney, PA 15767	11/15/2021 10:45 AM
Details	Last Recertification Date	Update	Recertification	9/4/2020 11:40:08 AM	9/8/2021 7:46:37 AM	9/8/2021 7:46 AM
Addresses	Shipping Address	Insert	Change Request		Penn Highlands Community Pharmacy Punxsutawney 21871 US-119 Punxsutawney, PA 15767	7/30/2021 1:36 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1063089415	7/30/2021 1:36 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	7/30/2021 1:36 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1417555616	6/22/2021 10:51 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	6/22/2021 10:51 AM
Addresses	Shipping Address	Insert	Change Request		Penn Highlands Clearfield 809 Turnpike Avenue Inpatient Pharmacy Clearfield, PA 16830	5/21/2021 5:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1316537228	5/21/2021 5:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	5/21/2021 5:48 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1053992966	5/21/2021 5:48 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	5/21/2021 5:48 PM
Contacts	Primary Contact	Update	Profile Change Request	Caruso, Bailey 340B Coordinator Penn Highlands Healthcare 8143756625	Voelker, Bailey 340B Coordinator Penn Highlands Healthcare 8143756625	4/22/2021 6:25 PM
Addresses	Shipping Address	Insert	Change Request		Penn Highlands Community Pharmacy Clarion 265 Holiday Inn Drive Route 68 Clarion, PA 16214	2/16/2021 10:47 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/4/2020 11:40 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/4/2020 11:40 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/4/2020 11:40 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/4/2020 11:40 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/4/2020 11:40 AM
Details	Last Recertification Date	Update	Recertification	9/15/2019 2:05:21 PM	9/4/2020 11:40:08 AM	9/4/2020 11:40 AM
Contacts	Primary Contact	Update	Profile Change Request	Caruso, Bailey 340B Associate Penn Highlands Healthcare 8143756625	Caruso, Bailey 340B Coordinator Penn Highlands Healthcare 8143756625	6/2/2020 8:04 AM
Contacts	Primary Contact	Update	Profile Change Request	Caruso, Bailey 340B Associate Penn Highlands 8142997554	Caruso, Bailey 340B Associate Penn Highlands Healthcare 8143756625	5/15/2020 5:52 PM
Contacts	Primary Contact	Update	Change Request	Miller, Jennifer 340B Coordinator Penn Highlands Healthcare 8143756625	Caruso, Bailey 340B Associate Penn Highlands 8142997554	5/15/2020 1:15 PM
Contacts	Primary Contact	Update	Change Request	Caruso, Bailey 340B Associate Penn Highlands 8142997554	Miller, Jennifer 340B Coordinator Penn Highlands Healthcare 8143756625	1/2/2020 7:09 AM
Contacts	Primary Contact	Update	Change Request	Miller, Jennifer 340B Coordinator Penn Highlands Healthcare 8143756625	Caruso, Bailey 340B Associate Penn Highlands 8142997554	10/24/2019 9:10 AM
Details	Last Recertification Date	Update	Recertification	8/24/2018 6:50:32 AM	9/15/2019 2:05:21 PM	9/15/2019 2:05 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1871512855	5/8/2019 7:14 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003079565	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		902352600	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003149125A	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1700444	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0485373	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	5/1/2019 2:08 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1912038159	5/1/2019 2:08 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/29/2019 7:10 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1144249657	4/29/2019 7:10 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	4/29/2019 7:10 AM
Contacts	Primary Contact	Update	Profile Change Request	Miller, Jennifer 340B Assistant Coordinator Penn Highlands Healthcare 8143756625	Miller, Jennifer 340B Coordinator Penn Highlands Healthcare 8143756625	4/26/2019 10:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/17/2019 9:04 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0295809	4/17/2019 9:04 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	4/17/2019 9:04 AM
Contacts	Primary Contact	Update	Change Request	Strini, Jessica 340B Coordinator Penn Highlands Healthcare 8143756553	Miller, Jennifer 340B Assistant Coordinator Penn Highlands Healthcare 8143756625	10/17/2018 8:28 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 1:04:20 PM	8/24/2018 6:50:32 AM	8/24/2018 6:50 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1336517648 ( )		5/22/2018 1:51 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1578679981	3/15/2018 4:27 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	11/15/2017 1:04:20 PM	11/15/2017 1:04 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1028232520001 (PA)		10/13/2017 6:34 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1912038159 ( )		10/13/2017 6:34 AM
Contacts	Primary Contact	Update	Change Request	IORFIDO, FRANCIS PHARMACY DIRECTOR 8143753762	Strini, Jessica 340B Coordinator Penn Highlands Healthcare 8143756553	9/28/2017 12:59 PM
Contacts	Authorizing Official	Update		Kline, Brian CFO 8143756377	Kline, Brian CFO Penn Highlands DuBois 8143756377	9/21/2017 4:26 PM
Contacts	Authorizing Official	Insert			Kline, Brian CFO 8143756377	8/9/2017 1:19 PM
Addresses	Shipping Address	Delete		Penn Highlands Community Pharmacy 621 S Main St DuBois, PA 15801		8/3/2017 1:42 PM
Addresses	Main Address	Insert			100 HOSPITAL AVENUE DUBOIS, PA 15801	8/3/2017 1:42 PM
Addresses	Billing Address	Insert			DuBois Regional Medical Center dba Penn Highlands DuBois 100 Hospital Ave PO Box 447 DuBois, PA 15801	8/3/2017 1:42 PM
Addresses	Shipping Address	Insert			DuBois Regional Medical Center 100 Hospital Ave DuBois, PA 15801	8/3/2017 1:42 PM
Addresses	Shipping Address	Insert			DuBois Regional Medical Center 635 Maple Ave Maple Division Pharmacy DuBois, PA 15801	8/3/2017 1:42 PM
Addresses	Shipping Address	Insert			Penn Highlands Community Pharmacy 621 S Main St DuBois, PA 15801	8/3/2017 1:42 PM
Addresses	Shipping Address	Insert			Penn Highlands Community Pharmacy 621 S Main St DuBois, PA 15801	8/3/2017 1:42 PM
Addresses	Shipping Address	Insert			McCabe Drug 419 Main St Reynoldsville, PA 15851	8/3/2017 1:42 PM
Contacts	Primary Contact	Insert			IORFIDO, FRANCIS PHARMACY DIRECTOR 8143753762	8/3/2017 1:42 PM
Medicaid Billing	NPI: Number	Insert			1912038159	8/3/2017 1:41 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/3/2017 1:41 PM
Medicaid Billing	Medicaid: Number	Insert			1028232520001	8/3/2017 1:41 PM
Medicaid Billing	Medicaid: State	Insert			PA	8/3/2017 1:41 PM
Details	Last Recertification Date	Update		8/10/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/11/2016 10:23 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/5/2015 11:00 AM
Medicaid Billing	Medicaid: Number	Insert			1007740880209	11/5/2015 11:00 AM
Medicaid Billing	Medicaid: State	Insert			PA	11/5/2015 11:00 AM
Medicaid Billing	NPI: Number	Insert			1336517648	9/15/2015 3:53 PM
Medicaid Billing	NPI: Number	Insert			1336517648	9/15/2015 3:53 PM
Details	Last Recertification Date	Update		8/27/2014 12:00:00 AM	8/10/2015 12:00:00 AM	8/10/2015 1:41 PM
Details	Last Recertification Date	Update		8/21/2013 12:00:00 AM	8/27/2014 12:00:00 AM	8/27/2014 7:22 AM
Details	Entity Subname	Update			dba Penn Highlands DuBois	8/27/2014 7:22 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	8/21/2013 2:41 PM
Medicaid Billing	Medicaid: Number	Insert			1007740880070	8/21/2013 2:41 PM
Medicaid Billing	Medicaid: State	Insert			PA	8/21/2013 2:41 PM
Medicaid Billing	NPI: Number	Insert			1144249657	8/21/2013 2:41 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/21/2013 12:00:00 AM	8/21/2013 2:41 PM
Dates	Participating Approval Date	Update		4/23/2008 9:43:52 AM	4/23/2008 12:00:00 AM	8/28/2012 7:31 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/21/2012 7:26 AM
Details	Last Recertification Date	Insert				4/23/2008 9:47 AM
Details	Grant Number	Insert				4/23/2008 9:47 AM
Details	340B ID	Insert			DSH390086	4/23/2008 9:47 AM
Details	Is Authorizing Official EHB Data	Insert				4/23/2008 9:47 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/23/2008 9:47 AM
Details	Medicare Provider Number	Insert			390086	4/23/2008 9:47 AM
Details	Entity Name	Insert			DUBOIS REGIONAL MEDICAL CENTER	4/23/2008 9:47 AM
Details	Program Code	Insert			DSH	4/23/2008 9:47 AM
Details	Entity Subname	Insert				4/23/2008 9:47 AM
Dates	Participating Approval Date	Insert			4/23/2008 9:43:52 AM	4/23/2008 9:47 AM
Details	State	Insert			Active	4/23/2008 9:47 AM
Dates	Registration Date	Insert			4/23/2008 12:00:00 AM	4/23/2008 9:47 AM
Dates	Signed By Date	Insert			8/13/2007 12:00:00 AM	4/23/2008 9:47 AM
Dates	Start Date	Insert			7/1/2004 12:00:00 AM	4/23/2008 9:47 AM
Terminations	Termination Comments	Insert				4/23/2008 9:47 AM
Terminations	Termination Date	Insert				4/23/2008 9:47 AM
Terminations	Termination Effective Date	Insert				4/23/2008 9:47 AM
Terminations	Termination Reason	Insert				4/23/2008 9:47 AM