Covered Entity Details

CAH391308-00 CORRY MEMORIAL HOSPITAL (Active) - information as of 5/13/2025 1:22:25 AM

Main Details

Name

CORRY MEMORIAL HOSPITAL

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH391308-00

Medicare Provider Number

391308

Additional Details

Current Program Status

Active

Registration Date

4/13/2015

Participating Start Date

7/1/2015

Participating Approval Date

6/1/2015

Last Recertification Date

8/30/2024

Contacts

Authorizing Official

Corry Memorial Hospital
Timothy McGahen, Chief Financial Officer
(814) 664-4641 Ext: 4105

Primary Contact

Corry Memorial Hospital
Kate McCray, Director of Finance
(814) 664-4641 Ext: 4106

Addresses

Street Address

965 SHAMROCK LANE
CORRY, PA 16407

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	Termination Date	Last Updated On
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05098	330 W. COLUMBUS AVE.	CORRY	PA	16407	06/25/2015	07/01/2015		01/11/2017
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #596	827 N. CENTER STREET	CORRY	PA	16407	04/09/2020	07/01/2020		07/01/2020
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1398	1 EAST HIGH STREET	UNION CITY	PA	16438	10/08/2020	01/01/2021		01/01/2021
Contract Detail	UNION CITY PHARMACY	16395 ROUTE 8		UNION CITY	PA	16438	10/15/2020	01/01/2021	05/23/2024	05/24/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	01/11/2017	04/01/2017		01/11/2017
Contract Detail	WAL-MART PHARMACY 10-2909	961 ROUTE 6		CORRY	PA	16407	06/25/2015	07/01/2015		01/11/2017
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/16/2018	07/01/2018	10/23/2018	10/01/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	01/11/2017	04/01/2017		01/11/2017
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/13/2023	10/01/2023	07/14/2023	08/23/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/14/2023	10/01/2023		10/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/02/2023	01/01/2024		01/01/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH391308-01	Child	CAH	CORRY MEMORIAL HOSPITAL	RURAL HEALTH CLINIC / FAMILY MEDICINE; PODIATRY	965 SHAMROCK LANE	CORRY	PA	Active
CAH391308-02	Child	CAH	CORRY MEMORIAL HOSPITAL	Union City Rural Health Clinic - Family Medicine	101 E High Street	Union City	PA	Active
CAH391308-03	Child	CAH	CORRY MEMORIAL HOSPITAL	Clymer Rural Health Clinic - Family Practice	354 Clymer Corry Road	Clymer	NY	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007699900030 (PA)		3/14/2025 12:07 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	100769900031 (PA)		3/14/2025 12:07 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	06993948 (NY)		3/14/2025 12:07 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1124406376 (PA)		3/14/2025 12:07 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1255967956 (PA)		3/14/2025 12:07 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1255922043 (NY)		3/14/2025 12:07 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1255922043 (PA)		3/14/2025 12:07 PM
Contacts	Primary Contact	Update	Profile Change Request	McCray, Kate Controller Corry Memorial Hospital 8146644641-4106	McCray, Kate Director of Finance Corry Memorial Hospital 8146644641-4106	12/6/2024 1:05 PM
Details	Last Recertification Date	Update	Recertification	9/1/2023 2:07:36 PM	8/30/2024 9:48:22 AM	8/30/2024 9:48 AM
Contacts	Authorizing Official	Update	Profile Change Request	McGahen, Timothy Chief Financial Officer Corry Memorial Hospital 8146644641-1041	McGahen, Timothy Chief Financial Officer Corry Memorial Hospital 8146644641-4105	12/22/2023 3:36 PM
Contacts	Primary Contact	Update	Profile Change Request	McCray, Kate Controller Corry Memorial Hospital 8146644641-1043	McCray, Kate Controller Corry Memorial Hospital 8146644641-4106	12/21/2023 12:22 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007699900022 (PA)		9/1/2023 2:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1841268877 (PA)		9/1/2023 2:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1851369938 (PA)		9/1/2023 2:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1255788014 (PA)		9/1/2023 2:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1518411677 (PA)		9/1/2023 2:07 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1255922043 (PA)		9/1/2023 2:07 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1255922043	9/1/2023 2:07 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2023 2:07 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 1:52:05 PM	9/1/2023 2:07:36 PM	9/1/2023 2:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007699900030	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		100769900031	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007699900022	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		06993948	12/10/2022 3:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1841268877	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1851369938	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1124406376	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255788014	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1518411677	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255967956	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255922043	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		PA	12/10/2022 3:33 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1255922043	12/10/2022 3:33 PM
Medicaid Billing	NPI: State	Insert	Change Request		NY	12/10/2022 3:33 PM
Details	Last Recertification Date	Update	Recertification	9/7/2021 9:55:25 AM	8/26/2022 1:52:05 PM	8/26/2022 1:52 PM
Contacts	Primary Contact	Update	Profile Change Request	McCray, Kate Staff Accountant Corry Memorial Hospital 8146644641-1043	McCray, Kate Controller Corry Memorial Hospital 8146644641-1043	3/22/2022 8:33 AM
Details	Last Recertification Date	Update	Recertification	8/20/2020 4:33:38 PM	9/7/2021 9:55:25 AM	9/7/2021 9:55 AM
Contacts	Authorizing Official	Update	Change Request	Heller, Michael Chief Financial Officer Corry Memorial Hospital 8146644641-1040	McGahen, Timothy Chief Financial Officer Corry Memorial Hospital 8146644641-1041	2/24/2021 12:18 PM
Contacts	Primary Contact	Update	Change Request	McGahen, Timothy Chief Financial Officer Corry Memorial Hospital 8146644641-1041	McCray, Kate Staff Accountant Corry Memorial Hospital 8146644641-1043	2/24/2021 12:18 PM
Contacts	Primary Contact	Update	Profile Change Request	McGahen, Timothy Director of Finance Corry Memorial Hospital 8146644641-1041	McGahen, Timothy Chief Financial Officer Corry Memorial Hospital 8146644641-1041	2/24/2021 11:17 AM
Details	Last Recertification Date	Update	Recertification	9/2/2019 1:13:31 PM	8/20/2020 4:33:38 PM	8/20/2020 4:33 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 4:45:16 PM	9/2/2019 1:13:31 PM	9/2/2019 1:13 PM
Contacts	Primary Contact	Update	Recertification	McGahen, Timothy Controller Corry Memorial Hospital 8146644641-1041	McGahen, Timothy Director of Finance Corry Memorial Hospital 8146644641-1041	8/29/2019 2:19 PM
Details	Last Recertification Date	Update	Recertification	11/7/2017 3:31:22 PM	8/21/2018 4:45:16 PM	8/21/2018 4:45 PM
Contacts	Primary Contact	Update	Recertification	Heller, Michael Chief Financial Officer 8146644641-1040	McGahen, Timothy Controller Corry Memorial Hospital 8146644641-1041	11/7/2017 3:31 PM
Details	Last Recertification Date	Update	Recertification	8/29/2016 12:00:00 AM	11/7/2017 3:31:22 PM	11/7/2017 3:31 PM
Contacts	Authorizing Official	Update		Heller, Michael Chief Financial Officer 8146644641-1040	Heller, Michael Chief Financial Officer Corry Memorial Hospital 8146644641-1040	11/1/2017 4:43 PM
Contacts	Signed By	Update		Heller, Michael Chief Financial Officer 8146644641-1040	Heller, Michael Chief Financial Officer Corry Memorial Hospital 8146644641-1040	11/1/2017 4:43 PM
Addresses	Main Address	Insert			965 SHAMROCK LANE CORRY, PA 16407	1/11/2017 6:15 PM
Contacts	Authorizing Official	Insert			Heller, Michael Chief Financial Officer 8146644641-1040	1/11/2017 6:15 PM
Contacts	Primary Contact	Insert			Heller, Michael Chief Financial Officer 8146644641-1040	1/11/2017 6:15 PM
Contacts	Signed By	Insert			Heller, Michael Chief Financial Officer 8146644641-1040	1/11/2017 6:15 PM
Details	Last Recertification Date	Update		9/2/2015 12:00:00 AM	8/29/2016 12:00:00 AM	8/29/2016 11:27 AM
Details	Last Recertification Date	Update			9/2/2015 12:00:00 AM	9/2/2015 10:57 AM
Dates	Participating Approval Date	Update			6/1/2015 12:00:00 AM	6/1/2015 9:34 AM
Details	State	Update		Pending	Active	6/1/2015 9:34 AM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	6/1/2015 9:34 AM
Details	340B ID	Update		ONLINE_REG_51164	CAH391308-00	4/14/2015 8:55 AM
Details	340B ID	Update			ONLINE_REG_51164	4/13/2015 9:56 AM
Details	Last Recertification Date	Insert				4/13/2015 9:56 AM
Details	Grant Number	Insert				4/13/2015 9:56 AM
Details	340B ID	Insert				4/13/2015 9:56 AM
Details	Is Authorizing Official EHB Data	Insert				4/13/2015 9:56 AM
Dates	Last Date That 340B Drugs Purchased	Insert				4/13/2015 9:56 AM
Details	Medicare Provider Number	Insert			391308	4/13/2015 9:56 AM
Details	Entity Name	Insert			CORRY MEMORIAL HOSPITAL	4/13/2015 9:56 AM
Details	Program Code	Insert			CAH	4/13/2015 9:56 AM
Details	Entity Subname	Insert				4/13/2015 9:56 AM
Dates	Participating Approval Date	Insert				4/13/2015 9:56 AM
Details	State	Insert			Pending	4/13/2015 9:56 AM
Dates	Registration Date	Insert			4/13/2015 12:00:00 AM	4/13/2015 9:56 AM
Dates	Signed By Date	Insert			4/13/2015 12:00:00 AM	4/13/2015 9:56 AM
Dates	Start Date	Insert				4/13/2015 9:56 AM
Terminations	Termination Comments	Insert				4/13/2015 9:56 AM
Terminations	Termination Date	Insert				4/13/2015 9:56 AM
Terminations	Termination Effective Date	Insert				4/13/2015 9:56 AM
Terminations	Termination Reason	Insert				4/13/2015 9:56 AM