Covered Entity Details

CAH391312-06 BROOKVILLE HOSPITAL (Active) - information as of 4/25/2025 9:22:52 PM

Main Details

Name

BROOKVILLE HOSPITAL

Subdivision Name

Penn Highlands Moshannon Valley Rural Health Center

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH391312-06

Medicare Provider Number

391312

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/5/2017

Participating Start Date

4/1/2017

Participating Approval Date

1/9/2017

Last Recertification Date

8/13/2024

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

271 Railroad Street
Philipsburg, PA 16866

Billing Address

Brookville Hospital
100 Hospital Road
Brookville, PA 15825

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	1007733760049	1417331554,1760452924

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.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
CAH391312-01	Child	CAH	BROOKVILLE HOSPITAL	ALLEGHENY HEALTH CENTER	22 INDUSTRIAL PARK ROAD	BROOKVILLE	PA	Terminated
CAH391312-02	Child	CAH	BROOKVILLE HOSPITAL	Penn Highlands Marienville Rural Health Center 95030	125 Chestnut Street	Marienville	PA	Active
CAH391312-03	Child	CAH	BROOKVILLE HOSPITAL	Penn Highlands New Bethlehem Rural Health Center	1323 Brookville Street	Fairmont City	PA	Active
CAH391312-04	Child	CAH	BROOKVILLE HOSPITAL	Penn Highlands Center for Children's Care	271 Railroad Street	Philipsburg	PA	Active
CAH391312-05	Child	CAH	BROOKVILLE HOSPITAL	Q Care Moshannon Valley	271 Railroad Street	Philipsburg	PA	Active
CAH391312-06	Child	CAH	BROOKVILLE HOSPITAL	Penn Highlands Moshannon Valley Rural Health Center	271 Railroad Street	Philipsburg	PA	Active
CAH391312-07	Child	CAH	BROOKVILLE HOSPITAL	Penn Highlands Family Medicine Brookville	88 Hospital Road	Brookville	PA	Active
CAH391312-08	Child	CAH	BROOKVILLE HOSPITAL	Penn Highlands General Surgery Brookville	88 Hospital Road	Brookville	PA	Active
CAH391312-09	Child	CAH	BROOKVILLE HOSPITAL	Penn Highlands Urology Brookville	88 Hospital Road	Brookville	PA	Terminated
CAH391312-10	Child	CAH	BROOKVILLE HOSPITAL	PHB Behavioral Health - Psychiatric/Psychological services	90 Hospital Road	Brookville	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	PEER, JULIANNE President Penn Highlands Brookville 8148491461	Norman, Mark COO Penn Highlands Healthcare 8143756608	11/18/2024 10:49 AM
Details	Last Recertification Date	Update	Recertification	8/16/2023 9:55:56 AM	8/13/2024 5:19:31 PM	8/13/2024 5:19 PM
Details	Last Recertification Date	Update	Recertification	9/7/2022 9:43:34 AM	8/16/2023 9:55:56 AM	8/16/2023 9:55 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	3/28/2023 9:03 AM
Details	Last Recertification Date	Update	Recertification	9/1/2021 3:17:10 PM	9/7/2022 9:43:34 AM	9/7/2022 9:43 AM
Details	Entity Subname	Update	Recertification	Penn Highlands Moshannon Valley Rural Health Center 95050	Penn Highlands Moshannon Valley Rural Health Center	9/7/2022 9:43 AM
Details	Last Recertification Date	Update	Recertification	8/27/2020 10:05:35 AM	9/1/2021 3:17:10 PM	9/1/2021 3:17 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
Medicaid Billing	NPI: State	Update	Recertification		PA	8/27/2020 10:05 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/27/2020 10:05 AM
Details	Last Recertification Date	Update	Recertification	8/20/2019 4:52:02 PM	8/27/2020 10:05:35 AM	8/27/2020 10:05 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	4/29/2020 3:11 PM
Details	Last Recertification Date	Update	Recertification	8/20/2018 8:21:18 AM	8/20/2019 4:52:02 PM	8/20/2019 4:52 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1760452924	5/15/2019 3:44 PM
Contacts	Authorizing Official	Update	AO Change Request	PEER, JULIANNE President Penn Highlands Brookville 8148491461	PEER, JULIANNE President Penn Highlands Brookville 8148491461	5/13/2019 2:42 PM
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
Contacts	Primary Contact	Update	Change Request	Strini, Jessica 340B Coordinator Penn Highlands Healthcare 8143756553	Miller, Jennifer 340B Assistant Coordinator Penn Highlands Healthcare 8143756625	10/16/2018 8:07 AM
Details	Last Recertification Date	Update	Recertification	11/7/2017 10:23:50 AM	8/20/2018 8:21:18 AM	8/20/2018 8:21 AM
Details	Entity Subname	Update	Change Request	Penn Highlands Internal Medicine Philipsburg 95050	Penn Highlands Moshannon Valley Rural Health Center 95050	4/24/2018 12:30 PM
Details	Last Recertification Date	Update	Recertification		11/7/2017 10:23:50 AM	11/7/2017 10:23 AM
Contacts	Authorizing Official	Update	Profile Change Request	PEER, JULIANNE Interim President Penn Highlands Brookville 8148491461	PEER, JULIANNE President Penn Highlands Brookville 8148491461	10/3/2017 1:01 PM
Contacts	Signed By	Update	Profile Change Request	PEER, JULIANNE Interim President Penn Highlands Brookville 8148491461	PEER, JULIANNE President Penn Highlands Brookville 8148491461	10/3/2017 1:01 PM
Contacts	Authorizing Official	Update		PEER, JULIANNE Interim President 8148491461	PEER, JULIANNE Interim President Penn Highlands Brookville 8148491461	10/3/2017 12:49 PM
Contacts	Signed By	Update		PEER, JULIANNE Interim President 8148491461	PEER, JULIANNE Interim President Penn Highlands Brookville 8148491461	10/3/2017 12:49 PM
Contacts	Primary Contact	Update		Strini, Jessica 340B Coordinator 8143756553	Strini, Jessica 340B Coordinator Penn Highlands Healthcare 8143756553	9/18/2017 2:33 PM
Contacts	Primary Contact	Insert			Strini, Jessica 340B Coordinator 8143756553	6/6/2017 10:36 AM
Contacts	Authorizing Official	Insert			PEER, JULIANNE Interim President 8148491461	4/13/2017 11:47 AM
Contacts	Signed By	Insert			PEER, JULIANNE Interim President 8148491461	4/13/2017 11:47 AM
Addresses	Main Address	Insert			271 Railroad Street Philipsburg, PA 16866	1/9/2017 6:17 PM
Addresses	Billing Address	Insert			Brookville Hospital 100 Hospital Road Brookville, PA 15825	1/9/2017 6:17 PM
Dates	Participating Approval Date	Update			1/9/2017 12:00:00 AM	1/9/2017 6:17 PM
Details	State	Update		Pending	Active	1/9/2017 6:17 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	1/9/2017 6:17 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_74008	CAH391312-06	1/9/2017 8:57 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_74008	1/5/2017 3:38 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/5/2017 3:38 PM
Medicaid Billing	Medicaid: Number	Insert			1007733760049	1/5/2017 3:38 PM
Medicaid Billing	Medicaid: State	Insert			PA	1/5/2017 3:38 PM
Medicaid Billing	NPI: Number	Insert			1417331554	1/5/2017 3:38 PM
Details	Last Recertification Date	Insert				1/5/2017 3:38 PM
Details	Grant Number	Insert				1/5/2017 3:38 PM
Details	340B ID	Insert				1/5/2017 3:38 PM
Details	Is Authorizing Official EHB Data	Insert				1/5/2017 3:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/5/2017 3:38 PM
Details	Medicare Provider Number	Insert			391312	1/5/2017 3:38 PM
Details	Entity Name	Insert			BROOKVILLE HOSPITAL	1/5/2017 3:38 PM
Details	Program Code	Insert			CAH	1/5/2017 3:38 PM
Details	Entity Subname	Insert			Penn Highlands Internal Medicine Philipsburg 95050	1/5/2017 3:38 PM
Dates	Participating Approval Date	Insert				1/5/2017 3:38 PM
Details	State	Insert			Pending	1/5/2017 3:38 PM
Dates	Registration Date	Insert			1/5/2017 12:00:00 AM	1/5/2017 3:38 PM
Dates	Signed By Date	Insert			1/5/2017 12:00:00 AM	1/5/2017 3:38 PM
Dates	Start Date	Insert				1/5/2017 3:38 PM
Terminations	Termination Comments	Insert				1/5/2017 3:38 PM
Terminations	Termination Date	Insert				1/5/2017 3:38 PM
Terminations	Termination Effective Date	Insert				1/5/2017 3:38 PM
Terminations	Termination Reason	Insert				1/5/2017 3:38 PM