Covered Entity Details

FP15801 Penn Highlands Life's Journey (Active) - information as of 5/10/2025 11:12:48 PM

Main Details

Name

Penn Highlands Life's Journey

Subdivision Name

DuBois

Type

Family Planning (Title X only)

340B ID

FP15801

Grant Number

FPHPA006508

Additional Details

Current Program Status

Active

Registration Date

10/12/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/31/2016

Last Recertification Date

5/6/2024

Contacts

Authorizing Official

Penn Highlands Healthcare
Heather B Schneider, System CFO
(814) 375-6432

Primary Contact

Penn Highlands Life's Journey
Danielle Assalone, RN
(814) 375-3336

Addresses

Street Address

123 Hospital Ave
2nd Floor
Dubois, PA 15801

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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	1035225110007	1689911232,1558868570

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.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	5/8/2023 4:29:15 PM	5/6/2024 7:15:36 AM	5/6/2024 7:15 AM
Details	Last Recertification Date	Update	Recertification	5/9/2022 7:03:13 AM	5/8/2023 4:29:15 PM	5/8/2023 4:29 PM
Addresses	Main Address	Update	Change Request	190 West Park Avenue Suite 9 Dubois, PA 15801	123 Hospital Ave 2nd Floor Dubois, PA 15801	1/4/2023 2:21 PM
Details	Grant Number	Update	Change Request	FPHPA006404	FPHPA006508	10/4/2022 1:35 PM
Contacts	Primary Contact	Update	PC Change Request	Walker, Sarah Program Manager/RN Penn Highlands Life's Journey 8143711900	Assalone, Danielle RN Penn Highlands Life's Journey 8143753336	5/17/2022 8:23 AM
Contacts	Authorizing Official	Update	AO Change Request	Kline, Brian CFO Penn Highlands DuBois 8143756377	Schneider, Heather B System CFO Penn Highlands Healthcare 8143756432	5/12/2022 6:24 AM
Details	Last Recertification Date	Update	Recertification	5/6/2021 5:52:30 AM	5/9/2022 7:03:13 AM	5/9/2022 7:03 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	5/6/2021 5:52 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	5/6/2021 5:52 AM
Details	Last Recertification Date	Update	Recertification	5/4/2020 6:51:25 AM	5/6/2021 5:52:30 AM	5/6/2021 5:52 AM
Details	Last Recertification Date	Update	Recertification	5/13/2019 11:34:49 AM	5/4/2020 6:51:25 AM	5/4/2020 6:51 AM
Contacts	Authorizing Official	Update	AO Change Request	Kelsey, Molly A Director of Financial Reporting Penn Highlands Life's Journey 8143711900	Kline, Brian CFO Penn Highlands DuBois 8143756377	5/1/2020 12:06 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	5/13/2019 11:34 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1035225110007	5/13/2019 11:34 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	5/13/2019 11:34 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1027904830001 (PA)		5/13/2019 11:34 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1558868570	5/13/2019 11:34 AM
Details	Last Recertification Date	Update	Recertification	4/25/2018 7:41:31 AM	5/13/2019 11:34:49 AM	5/13/2019 11:34 AM
Details	Grant Number	Update	Recertification	FPHPA036256	FPHPA006404	5/13/2019 11:34 AM
Contacts	Primary Contact	Update	Change Request	Walker, Sarah RNC Life's Journey OBGYN 8143711900-4	Walker, Sarah Program Manager/RN Penn Highlands Life's Journey 8143711900	8/1/2018 10:56 AM
Contacts	Authorizing Official	Update	Change Request	Kelsey, Molly CFO Life's Journey OBGYN 8143711900	Kelsey, Molly A Director of Financial Reporting Penn Highlands Life's Journey 8143711900	8/1/2018 10:56 AM
Details	Entity Name	Update	Change Request	Life's Journey OB/GYN, PC	Penn Highlands Life's Journey	8/1/2018 10:56 AM
Details	Last Recertification Date	Update	Recertification	4/26/2017 12:00:00 AM	4/25/2018 7:41:31 AM	4/25/2018 7:41 AM
Contacts	Primary Contact	Update	Recertification	Walker, Sarah RNC 8143711900	Walker, Sarah RNC Life's Journey OBGYN 8143711900-4	4/25/2018 7:41 AM
Contacts	Authorizing Official	Update		Kelsey, Molly CFO 8143711900	Kelsey, Molly CFO Life's Journey OBGYN 8143711900	1/8/2018 11:13 AM
Contacts	Signed By	Update		Leber, BJ CEO 4122882130	Leber, BJ CEO Adagio Health 4122882130	9/29/2017 2:10 PM
Contacts	Signed By	Insert			Leber, BJ CEO 4122882130	8/2/2017 2:23 PM
Addresses	Main Address	Insert			190 West Park Avenue Suite 9 dubois, PA 15801	4/26/2017 8:43 AM
Contacts	Authorizing Official	Insert			Kelsey, Molly CFO 8143711900	4/26/2017 8:43 AM
Contacts	Primary Contact	Insert			Walker, Sarah RNC 8143711900	4/26/2017 8:43 AM
Details	Last Recertification Date	Update			4/26/2017 12:00:00 AM	4/26/2017 8:43 AM
Dates	Participating Approval Date	Update			10/31/2016 12:00:00 AM	10/31/2016 6:10 PM
Details	State	Update		Pending	Active	10/31/2016 6:10 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/31/2016 6:10 PM
Details	340B ID	Update		ONLINE_REG_72939	FP15801	10/13/2016 1:45 PM
Details	Entity Subname	Update		LIfe's Journey OB\GYN DuBois	DuBois	10/13/2016 1:45 PM
Details	Grant Number	Update		1FPHPA0362560100	FPHPA036256	10/13/2016 8:29 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_72939	10/12/2016 10:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/12/2016 10:45 AM
Medicaid Billing	Medicaid: Number	Insert			1027904830001	10/12/2016 10:45 AM
Medicaid Billing	Medicaid: State	Insert			PA	10/12/2016 10:45 AM
Medicaid Billing	NPI: Number	Insert			1689911232	10/12/2016 10:45 AM
Details	Last Recertification Date	Insert				10/12/2016 10:45 AM
Details	Grant Number	Insert			1FPHPA0362560100	10/12/2016 10:45 AM
Details	340B ID	Insert			ONLINE_REG	10/12/2016 10:45 AM
Details	Is Authorizing Official EHB Data	Insert				10/12/2016 10:45 AM
Dates	Last Date That 340B Drugs Purchased	Insert				10/12/2016 10:45 AM
Details	Medicare Provider Number	Insert				10/12/2016 10:45 AM
Details	Entity Name	Insert			Life's Journey OB/GYN, PC	10/12/2016 10:45 AM
Details	Program Code	Insert			FP	10/12/2016 10:45 AM
Details	Entity Subname	Insert			LIfe's Journey OB\GYN DuBois	10/12/2016 10:45 AM
Dates	Participating Approval Date	Insert				10/12/2016 10:45 AM
Details	State	Insert			Pending	10/12/2016 10:45 AM
Dates	Registration Date	Insert			10/12/2016 12:00:00 AM	10/12/2016 10:45 AM
Dates	Signed By Date	Insert			10/12/2016 12:00:00 AM	10/12/2016 10:45 AM
Dates	Start Date	Insert				10/12/2016 10:45 AM
Terminations	Termination Comments	Insert				10/12/2016 10:45 AM
Terminations	Termination Date	Insert				10/12/2016 10:45 AM
Terminations	Termination Effective Date	Insert				10/12/2016 10:45 AM
Terminations	Termination Reason	Insert				10/12/2016 10:45 AM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History