340B Drug Pricing Program Database


CAH391313-00 CHARLES COLE MEMORIAL HOSPITAL (Active) - information as of 6/3/2025 11:59:14 AM

Main Details
CHARLES COLE MEMORIAL HOSPITAL
Critical Access Hospital
Yes
CAH391313-00
391313


Additional Details
Active
8/17/2010
8/25/2010
8/17/2010
9/4/2024

Contacts

UPMC Susquehanna
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175

UPMC
Jessica St.Onge, 340B Manager
(302) 943-1813

Addresses

1001 EAST 2ND STREET
COUDERSPORT, PA 16915

UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain
PO Box 2058
Portland, OR 97208


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
10/29/2010- UPDATED MEDICAID INFO.(WAS 100001127-0109 AND NPI- 1417919945)10/29/2010
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA100001127,0010212201326161662,1487616470,1992729305,1619008554,1114195666,1164406401,1083632657,1013937457,1033283437,1164594495,1275605750,1003988502,1275605776,1629191358,1407928757,1427129139,1861564106
Shipping Addresses

HC PHARMACY CENTRAL
3175 E CARSON ST
PITTSBURGH, PA 15203

UPMC COLE PHARMACY
1001 E 2ND ST
COUDERSPORT, PA 16915

UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain
3175 E Carson St
Pittsburgh, PA 15203
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/12/202407/01/2024  07/01/2024
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/12/202407/01/2024  07/01/2024
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/12/202407/01/2024  07/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/12/202407/01/2024  07/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/12/202407/01/2024  07/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/12/202407/01/2024  07/01/2024
Contract DetailBUCHANAN BROTHERS PHARMACY122 W MAIN ST
WESTFIELDPA16950-152210/20/201102/01/2011  03/28/2013
Contract DetailBUCHANAN BROTHERS PHARMACYINC 170 MAIN ST
ELDREDPA1673110/20/201102/01/2011 04/07/202405/13/2024
Contract DetailBUCHANAN BROTHERS PHARMACY313 W MAIN ST
SMETHPORTPA1674910/20/201102/01/2011 04/07/202405/13/2024
Contract DetailBUCHANAN BROTHERS PHARMACY206 W MAIN ST
ELKLANDPA1692010/20/201102/01/2011  03/28/2013
Contract DetailBUCHANAN BROTHERS PHARMACY101 N MAIN ST
COUDERSPORTPA1691510/20/201102/01/2011 04/07/202405/13/2024
Contract DetailCHARTWELL PENNSYLVANIA1001 OAKDALE RD
OAKDALEPA15071-150204/09/202507/01/2025  04/09/2025
Contract DetailCYSTIC FIBROSIS SERVICESCYSTIC FIBROSIS SERVICES, INC 10530 JOHN W ELLIOTT DR, STE 200
FRISCOTX7503307/01/201510/01/2015 08/09/201708/14/2017
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503306/29/201707/01/2017 06/15/202505/15/2025
Contract DetailECKERD CORPORATIONRITE AID #10885 110 BOLIVAR ROAD
WELLSVILLENY1489507/10/201510/01/2015 02/20/201803/08/2018
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111204/12/202407/01/2024  07/01/2024
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313404/12/202407/01/2024  07/01/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/12/202407/01/2024  07/01/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/12/202407/01/2024  07/01/2024
Contract DetailGAUGHN'S DRUG STOREGAUGHN'S DRUG STORE 348 PENNSYLVANIA AVE WEST
WARRENPA1636507/08/202010/01/2020 07/03/202407/03/2024
Contract DetailONCOMED PHARMACEUTICAL SERVICES OF MA, LD/B/A ONCO360 335 BEAR HILL RD
STE 2100 		WALTHAMMA0245104/12/202407/01/2024  07/01/2024
Contract DetailPORT ALLEGANY PHARMACY54-56 N MAIN ST
PORT ALLEGANYPA16743-167402/07/201203/01/2012 07/03/202407/03/2024
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999207/17/201710/01/2017 10/20/202210/20/2022
Contract DetailRite Aid 6811701 Delran Pkwy
DelranNJ0807504/15/202507/01/2025 06/15/202505/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1976 207 ROUTE 6 WEST
COUDERSPORTPA1691509/12/201210/01/2012 06/15/202505/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2474 59 NORTH MAIN STREET
PORT ALLEGANYPA1674309/12/201210/01/2012 06/15/202505/15/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #7850 620 E ALLEGHENY AVENUE
EMPORIUMPA1583409/12/201210/01/2012 06/15/202505/15/2025
Contract DetailSINA DRUG LLCD/B/A ONCO 360 13410 EASTPOINT CENTRE DR
STE 101 		LOUISVILLEKY4022304/12/202407/01/2024  07/01/2024
Contract DetailSINA DRUG LLCDBA ONCO360 1985 MARCUS AVE STE 120
NEW HYDE PARKNY1104204/12/202407/01/2024  07/01/2024
Contract DetailSPROUT'S DRUG STORE122 EAST ACADEMY STREET
SHINGLEHOUSEPA1674804/18/201807/01/2018  04/08/2019
Contract DetailSPROUT'S DRUG STORE INC  122 EAST ACADEMY STREET
BOX 339 		SHINGLEHOUSEPA16748-033902/07/201203/01/2012 07/10/201507/10/2015
Contract DetailTHE PHARMACY AT UNION SQUARE36 DAVIS ST
BRADFORDPA16701-201604/08/201907/01/2019 12/13/201912/13/2019
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/17/201710/01/2017  10/01/2017
Contract DetailWAL-MART PHARMACY 10-2159RTE 417 1869 PLAZA DR
OLEANNY1476001/03/201404/01/2014  01/03/2014
Contract DetailWAL-MART PHARMACY 10-351450 FOSTER BROOK BLVD
BRADFORDPA1670101/03/201404/01/2014  01/03/2014
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/17/201710/01/2017  10/01/2017
Contract DetailWALGREEN EASTERN CO.DBA: WALGREENS #12381 10 N. MAIN ST.
WELLSVILLENY14895-123204/16/201507/01/2015 06/15/202505/15/2025
Contract DetailWALGREEN EASTERN CO., INC.DBA: WALGREENS #17344 4175 STATE ROUTE 417
WELLSVILLENY1489503/08/201803/08/2018  03/08/2018
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700807/01/201510/01/2015 10/01/202110/14/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818807/01/201510/01/2015 06/15/202505/15/2025
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/01/201510/01/2015 06/15/202505/15/2025
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503307/01/201510/01/2015 06/15/202505/15/2025
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH391313-01ChildCAHCHARLES COLE MEMORIAL HOSPITALCOUDERSPORT FAMILY MEDICINE1001 EAST 2ND STREETCOUDERSPORTPAActive
CAH391313-02ChildCAHCHARLES COLE MEMORIAL HOSPITALELDRED HEALTH CENTER139 MAIN STREETELDREDPAActive
CAH391313-03ChildCAHCHARLES COLE MEMORIAL HOSPITALEMPORIUM HEALTH CENTER288 SIZERVILLE ROADEMPORIUMPAActive
CAH391313-04ChildCAHCHARLES COLE MEMORIAL HOSPITALGALETON HEALTH CENTER30 RIVER STREETGALETONPAActive
CAH391313-05ChildCAHCHARLES COLE MEMORIAL HOSPITALPORT ALLEGANY HEALTH CENTER45 PINE STREETPORT ALLEGANYPAActive
CAH391313-06ChildCAHCHARLES COLE MEMORIAL HOSPITALSHINGLEHOUSE HEALTH CENTER129 N Puritan StreetSHINGLEHOUSEPAActive
CAH391313-07ChildCAHCHARLES COLE MEMORIAL HOSPITALNORTHERN POTTER HEALTH CENTER511 ACADEMY ST.ULYSSESPAActive
CAH391313-08ChildCAHCHARLES COLE MEMORIAL HOSPITALWESTFIELD HEALTH CENTER222 CHURCH STREETWESTFIELDPAActive
CAH391313-09ChildCAHCHARLES COLE MEMORIAL HOSPITALBOWMAN HEALTH CENTER83 S MARVIN STREETSMETHPORTPAActive
CAH391313-10ChildCAHCHARLES COLE MEMORIAL HOSPITALCENTRAL POTTER HEALTH CENTER71 ELK STREETCOUDERSPORTPAActive
CAH391313-11ChildCAHCHARLES COLE MEMORIAL HOSPITALOncology - Medical Oncology39 Memorial DriveCoudersportPAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesBilling AddressInsertGroup Change Request UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain PO Box 2058 Portland, OR 972085/15/2025 1:43 PM
AddressesShipping AddressInsertGroup Change Request UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain 3175 E Carson St Pittsburgh, PA 152035/15/2025 1:43 PM
ContactsPrimary ContactUpdatePC Change RequestMalacarne PharmD, Dr Gary E Director of Pharmacy UPMC Cole 8142605314St.Onge, Jessica 340B Manager UPMC 30294318133/5/2025 6:04 AM
DetailsLast Recertification DateUpdateRecertification8/24/2023 12:52:15 PM9/4/2024 12:27:05 PM9/4/2024 12:27 PM
AddressesShipping AddressInsertChange Request HC PHARMACY CENTRAL 3175 E CARSON ST PITTSBURGH, PA 152032/21/2024 11:01 AM
AddressesShipping AddressInsertChange Request UPMC COLE PHARMACY 1001 E 2ND ST COUDERSPORT, PA 169152/21/2024 11:01 AM
DetailsLast Recertification DateUpdateRecertification9/5/2022 9:07:34 AM8/24/2023 12:52:15 PM8/24/2023 12:52 PM
ContactsAuthorizing OfficialUpdateAO Change RequestRapp, Ron CFO UPMC Cole 8142605250Yost, Roger C CFO, North-Central PA Region UPMC Susquehanna 57032131755/22/2023 6:29 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 5:07:49 PM9/5/2022 9:07:34 AM9/5/2022 9:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/23/2022 10:22 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 1000011278/23/2022 10:22 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/23/2022 10:22 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 0010212208/23/2022 10:22 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 13261616628/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 14876164708/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19927293058/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16190085548/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 11141956668/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 11644064018/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10836326578/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10139374578/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10332834378/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 11645944958/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 12756057508/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10039885028/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 12756057768/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16291913588/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 14079287578/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 14271291398/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 18615641068/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
DetailsLast Recertification DateUpdateRecertification8/28/2020 9:40:06 AM9/9/2021 5:07:49 PM9/9/2021 5:07 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestRapp, Ron VP of Finance UPMC Cole 8142605250Rapp, Ron CFO UPMC Cole 81426052503/3/2021 9:53 AM
DetailsLast Recertification DateUpdateRecertification9/5/2019 9:06:11 AM8/28/2020 9:40:06 AM8/28/2020 9:40 AM
DetailsLast Recertification DateUpdateRecertification9/5/2018 10:39:26 AM9/5/2019 9:06:11 AM9/5/2019 9:06 AM
ContactsPrimary ContactUpdateChange RequestPitcher, Lora Director of Finance UPMC Cole 8142605237Malacarne PharmD, Dr Gary E Director of Pharmacy UPMC Cole 81426053143/28/2019 10:17 AM
ContactsPrimary ContactUpdateChange RequestPitcher, Lora Director of Finance UPMC Cole 8142605237Pitcher, Lora Director of Finance UPMC Cole 814260523711/16/2018 1:48 PM
ContactsAuthorizing OfficialUpdateChange RequestRapp, Ron VP Finance Charles Cole Memorial Hospital 8142745250Rapp, Ron VP of Finance UPMC Cole 814260525011/16/2018 1:48 PM
ContactsPrimary ContactUpdateProfile Change RequestPitcher, Lora Director of Finance Charles Cole Memorial Hospital 8142605259Pitcher, Lora Director of Finance UPMC Cole 814260523711/16/2018 11:24 AM
DetailsLast Recertification DateUpdateRecertification11/3/2017 1:11:45 PM9/5/2018 10:39:26 AM9/5/2018 10:39 AM
DetailsLast Recertification DateUpdateRecertification8/10/2016 12:00:00 AM11/3/2017 1:11:45 PM11/3/2017 1:11 PM
ContactsAuthorizing OfficialInsertChange Request Rapp, Ron VP Finance Charles Cole Memorial Hospital 81427452509/21/2017 12:48 PM
ContactsPrimary ContactUpdateChange RequestRapp, Ron VP Finance 8142745250Pitcher, Lora Director of Finance Charles Cole Memorial Hospital 81426052599/21/2017 12:48 PM
AddressesMain AddressInsert   1001 EAST 2ND STREET COUDERSPORT, PA 1691511/7/2016 1:38 PM
ContactsPrimary ContactUpdate Walters, Janice Executive Director 8142745240Rapp, Ron VP Finance 814274525011/7/2016 1:38 PM
ContactsPrimary ContactInsert  Walters, Janice Executive Director 81427452408/10/2016 11:11 AM
DetailsLast Recertification DateUpdate 8/6/2015 12:00:00 AM8/10/2016 12:00:00 AM8/10/2016 10:49 AM
DetailsLast Recertification DateUpdate 8/12/2014 12:00:00 AM8/6/2015 12:00:00 AM8/6/2015 1:47 PM
DetailsLast Recertification DateUpdate 8/27/2013 2:00:11 PM8/12/2014 12:00:00 AM8/12/2014 9:42 AM
DetailsLast Recertification DateUpdate 7/1/2012 12:00:00 AM8/27/2013 2:00:11 PM8/27/2013 2:00 PM
DetailsLast Recertification DateUpdate  7/1/2012 12:00:00 AM5/8/2012 10:48 AM
DetailsLast Recertification DateInsert   10/29/2010 2:38 PM
DetailsGrant NumberInsert   10/29/2010 2:38 PM
Details340B IDInsert  CAH391313-0010/29/2010 2:38 PM
DetailsIs Authorizing Official EHB DataInsert   10/29/2010 2:38 PM
DatesLast Date That 340B Drugs PurchasedInsert   10/29/2010 2:38 PM
DetailsMedicare Provider NumberInsert  39131310/29/2010 2:38 PM
DetailsEntity NameInsert  CHARLES COLE MEMORIAL HOSPITAL10/29/2010 2:38 PM
DetailsProgram CodeInsert  CAH10/29/2010 2:38 PM
DetailsEntity SubnameInsert   10/29/2010 2:38 PM
DatesParticipating Approval DateInsert  8/17/2010 12:00:00 AM10/29/2010 2:38 PM
DetailsStateInsert  Active10/29/2010 2:38 PM
DatesRegistration DateInsert  8/17/2010 12:00:00 AM10/29/2010 2:38 PM
DatesSigned By DateInsert  8/17/2010 12:00:00 AM10/29/2010 2:38 PM
DatesStart DateInsert  8/25/2010 12:00:00 AM10/29/2010 2:38 PM
TerminationsTermination CommentsInsert   10/29/2010 2:38 PM
TerminationsTermination DateInsert   10/29/2010 2:38 PM
TerminationsTermination Effective DateInsert   10/29/2010 2:38 PM
TerminationsTermination ReasonInsert   10/29/2010 2:38 PM
DetailsComments PublicInsert  10/29/2010- UPDATED MEDICAID INFO.(WAS 100001127-0109 AND NPI- 1417919945)10/29/2010 2:38 PM