Covered Entity Details

CAH391308-01 CORRY MEMORIAL HOSPITAL (Active) - information as of 5/13/2025 10:51:54 PM

Main Details

Name

CORRY MEMORIAL HOSPITAL

Subdivision Name

RURAL HEALTH CLINIC / FAMILY MEDICINE; PODIATRY

Type

Critical Access Hospital

Rural

340B ID

CAH391308-01

Medicare Provider Number

391308

Outpatient Facility Provider Number

393435

Additional Details

Current Program Status

Active

Registration Date

1/6/2017

Participating Start Date

4/1/2017

Participating Approval Date

1/11/2017

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?
Yes

State	Medicaid Number	NPI Number
PA		1124406376

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
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
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 2:11:00 PM	8/30/2024 9:44:26 AM	8/30/2024 9:44 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	NPI: Number	Insert	Recertification		1124406376	9/1/2023 2:11 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2023 2:11 PM
Details	Last Recertification Date	Update	Recertification	8/26/2022 1:55:46 PM	9/1/2023 2:11:00 PM	9/1/2023 2:11 PM
Details	Last Recertification Date	Update	Recertification	9/6/2021 10:13:03 AM	8/26/2022 1:55:46 PM	8/26/2022 1:55 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 9:17:28 AM	9/6/2021 10:13:03 AM	9/6/2021 10:13 AM
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	2/28/2021 9:56 PM
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	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 1:13:45 PM	8/20/2020 9:17:28 AM	8/20/2020 9:17 AM
Addresses	Main Address	Update	Recertification	300 YORK STREET CORRY, PA 16407-1420	965 SHAMROCK LANE CORRY, PA 16407	9/2/2019 1:13 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 4:29:31 PM	9/2/2019 1:13:45 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 3:34:22 PM	8/17/2018 4:29:31 PM	8/17/2018 4:29 PM
Contacts	Primary Contact	Update	Recertification	Heller, Michael Chief Financial Officer 8146644641-1040	McGahen, Timothy Controller Corry Memorial Hospital 8146644641-1041	11/7/2017 3:34 PM
Details	Last Recertification Date	Update	Recertification		11/7/2017 3:34:22 PM	11/7/2017 3:34 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			300 YORK STREET CORRY, PA 16407-1420	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
Dates	Participating Approval Date	Update			1/11/2017 12:00:00 AM	1/11/2017 6:15 PM
Details	State	Update		Pending	Active	1/11/2017 6:15 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	1/11/2017 6:15 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_74118	CAH391308-01	1/10/2017 12:41 PM
Details	Entity Subname	Update		CORRY MEMORIAL HOSPITAL RURAL HEALTH CLINIC / FAMILY MEDICINE; PODIATRY	RURAL HEALTH CLINIC / FAMILY MEDICINE; PODIATRY	1/9/2017 1:49 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_74118	1/6/2017 2:34 PM
Details	Last Recertification Date	Insert				1/6/2017 2:34 PM
Details	Grant Number	Insert				1/6/2017 2:34 PM
Details	340B ID	Insert				1/6/2017 2:34 PM
Details	Is Authorizing Official EHB Data	Insert				1/6/2017 2:34 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/6/2017 2:34 PM
Details	Medicare Provider Number	Insert			391308	1/6/2017 2:34 PM
Details	Entity Name	Insert			CORRY MEMORIAL HOSPITAL	1/6/2017 2:34 PM
Details	Program Code	Insert			CAH	1/6/2017 2:34 PM
Details	Entity Subname	Insert			CORRY MEMORIAL HOSPITAL RURAL HEALTH CLINIC / FAMILY MEDICINE; PODIATRY	1/6/2017 2:34 PM
Dates	Participating Approval Date	Insert				1/6/2017 2:34 PM
Details	State	Insert			Pending	1/6/2017 2:34 PM
Dates	Registration Date	Insert			1/6/2017 12:00:00 AM	1/6/2017 2:34 PM
Dates	Signed By Date	Insert			1/6/2017 12:00:00 AM	1/6/2017 2:34 PM
Dates	Start Date	Insert				1/6/2017 2:34 PM
Terminations	Termination Comments	Insert				1/6/2017 2:34 PM
Terminations	Termination Date	Insert				1/6/2017 2:34 PM
Terminations	Termination Effective Date	Insert				1/6/2017 2:34 PM
Terminations	Termination Reason	Insert				1/6/2017 2:34 PM