Covered Entity Details

DSH390086FA DUBOIS REGIONAL MEDICAL CENTER (Active) - information as of 4/25/2025 8:34:44 PM

Main Details

Name

DUBOIS REGIONAL MEDICAL CENTER

Subdivision Name

Penn Highlands Family Medicine Residency Clinic 90570

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390086FA

Medicare Provider Number

390086

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/12/2018

Participating Start Date

7/1/2018

Participating Approval Date

5/14/2018

Last Recertification Date

8/12/2024

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

145 Hospital Ave
Suite 315
DuBois, PA 15801

Billing Address

Penn Highlands DuBois
100 Hospital Ave
PO Box 447
DuBois, PA 15801

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	1007740880225	1144249657

Shipping Addresses

Shipping Address 1

Penn Highlands DuBois Pharmacy
100 Hospital Ave
DuBois, PA 15801

Shipping Address 2

Penn Highlands Family Medicine Residency Clinic
145 Hospital Ave
Suite 315
DuBois, PA 15801

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
DSH390086AC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery DuBois 90910	145 Hospital Avenue	DuBois	PA	Terminated
DSH390086AD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Perinatal Consultants 90800	869 Beaver Drive	DuBois	PA	Terminated
DSH390086AE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois	65 Developac Road	DuBois	PA	Active
DSH390086AF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Wound Center	635 Maple Ave	DuBois	PA	Active
DSH390086AK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology Brookville	88 Hospital Road	Brookville	PA	Active
DSH390086AL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology Clearfield	807 Turnpike Ave	Clearfield	PA	Active
DSH390086AM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Ridgway 94275	123 South Street	Ridgway	PA	Terminated
DSH390086AN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys	177 Washington Street	St Marys	PA	Active
DSH390086AR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine DuBois	145 Hospital Ave	DuBois	PA	Active
DSH390086AS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois	145 Hospital Avenue	DuBois	PA	Active
DSH390086AU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Infectious Disease 90660	635 Maple Ave	DuBois	PA	Terminated
DSH390086AW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine 94280	416 North Broad St	Emporium	PA	Terminated
DSH390086AX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology DuBois	145 Hospital Ave	DuBois	PA	Active
DSH390086AY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery DuBois	145 Hospital Ave	DuBois	PA	Active
DSH390086AZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology St Marys	1100 Million Dollar Highway	St Marys	PA	Terminated
DSH390086BA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology DuBois 90610	145 Hospital Ave	DuBois	PA	Active
DSH390086BB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurology St Marys	1100 Million Dollar Highway	St Marys	PA	Active
DSH390086BC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurology DuBois	123 Hospital Ave	DuBois	PA	Active
DSH390086BF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Behavioral Health DuBois 71110	635 Maple Avenue	DuBois	PA	Active
DSH390086BG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Behavioral Health St Marys 71110	1100 Million Dollar Highway	St Marys	PA	Terminated
DSH390086BH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Hyperbaric Oxygen Therapy 77420	635 Maple Avenue	DuBois	PA	Terminated
DSH390086BN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Fracture Clinic	123 Hospital Ave	DuBois	PA	Terminated
DSH390086BP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Integrated Primary Care 71130	100 Caldwell Drive	DuBois	PA	Terminated
DSH390086BQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Oncology/Hematology Clearfield 78760	815 Doctors Drive	Clearfield	PA	Active
DSH390086BR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center DuBois 78200	145 Hospital Ave	DuBois	PA	Active
DSH390086BS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center DuBois 90780	145 Hospital Ave	DuBois	PA	Active
DSH390086BT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine Ridgway 94271	99 Hospital Street	Ridgway	PA	Terminated
DSH390086BU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pulmonology and Sleep Medicine St Marys	1100 Million Dollar Highway	St Marys	PA	Active
DSH390086BY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Women's Care DuBois 90700	145 Hospital Avenue	DUBOIS	PA	Terminated
DSH390086BZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endoscopy Center	621 South Main Street	DUBOIS	PA	Terminated
DSH390086C	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois 90570	145 Hospital Avenue	DuBois	PA	Terminated
DSH390086CA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Cardiopulmonary	100 HOSPITAL AVE	DUBOIS	PA	Terminated
DSH390086CB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands DuBois Sleep Lab 75900	621 South Main Street	DUBOIS	PA	Active
DSH390086CC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90570	145 Hospital Ave	DUBOIS	PA	Terminated
DSH390086CD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology Philipsburg 90740	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086CE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center DuBois 90670	100 HOSPITAL AVE	DUBOIS	PA	Active
DSH390086CF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Clearfield 90670	815 Doctor's Drive	Clearfield	PA	Active
DSH390086CG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Brookville 90670	88 Hospital Road	Brookville	PA	Active
DSH390086CH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology Clearfield 93370	531 Hannah Street	Clearfield	PA	Terminated
DSH390086CJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology St Marys 93370	1095 Million Dollar Highway	St. Marys	PA	Terminated
DSH390086CK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Dermatology 90750	90 Beaver Drive	DUBOIS	PA	Terminated
DSH390086CL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Clearfield 93210	502 Park Avenue	Clearfield	PA	Terminated
DSH390086CM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois 90570	145 Hospital Ave	DuBois	PA	Terminated
DSH390086CN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Clearfield 93230	807 Turnpike Ave.	Clearfield	PA	Active
DSH390086CP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine / Q Care Ridgway 94180	250 W Main St.	Ridgway	PA	Active
DSH390086CQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Cameron County 94160	416 North Broad Street	Emporium	PA	Terminated
DSH390086CR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Ridgway 94130	104 Metoxet Street	Ridgway	PA	Terminated
DSH390086CS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care St Marys 94270	761 Johnsonburg Road	St. Marys	PA	Active
DSH390086CT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics Brookville 90720	2834 Maplevale Rd	Brookville	PA	Terminated
DSH390086CU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics St Marys 94310	761 Johnsonburg Rd	St Marys	PA	Terminated
DSH390086CV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics Midline 90720	135B Midline Drive	DuBois	PA	Terminated
DSH390086CW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics DuBois 90720	529 Sunflower Drive	DuBois	PA	Terminated
DSH390086CX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine Clearfield 93250	531B Hannah Street	Clearfield	PA	Terminated
DSH390086CY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pediatrics GRAH/MAR/SOR - Clearfield 93260	1033 Turnpike Avenue	Clearfield	PA	Active
DSH390086CZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Center Pediatrics Grah/Mar/Sor -Philipsburg 93260	1049 North Front Street	Philipsburg	PA	Terminated
DSH390086D	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Brookville 95550	240 Allegheny Blvd	Brookville	PA	Terminated
DSH390086DA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Clearfield	815 Doctor's Drive	Clearfield	PA	Active
DSH390086DB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Philipsburg 93290	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086DC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine Philipsburg	271 Railroad Street	Philipsburg	PA	Active
DSH390086DD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopaedics Clearfield 93310	807 Turnpike Avenue	Clearfield	PA	Terminated
DSH390086DE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology Clearfield 90835	807 Turnpike Avenue	Clearfield	PA	Active
DSH390086DF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Obstetrics Carnevale - Clearfield 93350	807 Turnpike Avenue	Clearfield	PA	Terminated
DSH390086DG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94140	1100 Million Dollar Highway	St. Marys	PA	Active
DSH390086DH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine St Marys 94190	761 Johnsonburg Road	St. Marys	PA	Active
DSH390086DJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Johnsonburg 94300	111-114 Cobb Street	Johnsonburg	PA	Terminated
DSH390086DK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St. Marys 94170	757 Johnsonburg Road	St. Marys	PA	Active
DSH390086DL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Emporium 94170	275 East Fourth Street	Emporium	PA	Terminated
DSH390086DM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94170	757 Johnsonburg Road	St. Marys	PA	Active
DSH390086DN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine St Marys 90760	761 Johnsonburg Road	St. Marys	PA	Active
DSH390086DP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands OB/GYN Koch/Batchev - 94230	761 Johnsonburg Road	St. Marys	PA	Terminated
DSH390086DQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94250	761 Johnsonburg Road	St. Marys	PA	Terminated
DSH390086DR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	POHE OB LIN - Women's Care 94290	761 Johnsonburg Road	St. Marys	PA	Terminated
DSH390086DS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Apnea/Reflux Clinic 78500	145 HOSPITAL AVE	DUBOIS	PA	Active
DSH390086DT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Punxsy 94120	551 W. Mahoning St.	Punxsutawney	PA	Terminated
DSH390086DU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Ridgway 94240	123 South Street	Ridgway	PA	Terminated
DSH390086DV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Punxsy 90890	104 West Mahoning Street	Punxsutawney	PA	Terminated
DSH390086DW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Breast Care Services	123 Hospital Ave	DuBois	PA	Active
DSH390086DX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery St Marys	761 Johnsonburg Rd	St Marys	PA	Active
DSH390086DY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands DuBois Surgery Center	95 Hoover Ave	DuBois	PA	Active
DSH390086DZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine-Donahue	145 Hospital Ave	DuBois	PA	Terminated
DSH390086E	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology Brookville 95570	240 Allegheny Blvd.	Brookville	PA	Terminated
DSH390086EA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Clearfield 90780	815 Doctors Drive	Clearfield	PA	Active
DSH390086EB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center St Marys	1100 Million Dollar Hwy	St Marys	PA	Active
DSH390086EC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Philipsburg 90610	271 Railroad St.	Philipsburg	PA	Active
DSH390086ED	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Punxsy 90610	21911 Route 119	Punxsutawney	PA	Terminated
DSH390086EE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center Philipsburg 78200	271 Railroad St.	Philipsburg	PA	Active
DSH390086EF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Philipsburg 90670	271 Railroad St.	Philipsburg	PA	Active
DSH390086EG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Punxsy 90670	21911 Route 119	Punxsutawney	PA	Active
DSH390086EH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center Punxsy 78200	21911 Route 119	Punxsutawney	PA	Terminated
DSH390086EJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Internal Medicine DuBois 90660	145 Hospital Ave.	DuBois	PA	Active
DSH390086EK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Clearfield 90610	807 Turnpike Ave	Clearfield	PA	Terminated
DSH390086EL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Philipsburg 90780	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086EM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care DuBois 90920	621 South Main Street	DuBois	PA	Active
DSH390086EN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Punxsutawney 90950	21911 Route 119	Punxsutawney	PA	Active
DSH390086EP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Sports Medicine 93390	271 Railroad Street	Philipsburg	PA	Terminated
DSH390086EQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology Brookville 90630	88 Hospital Road	Brookville	PA	Terminated
DSH390086ER	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology Punxsy 90630	21911 Route 119	Punxsutawney	PA	Terminated
DSH390086ES	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology St Marys	1100 Million Dollar Highway	St Marys	PA	Active
DSH390086ET	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Clarion 90670	265 Holiday Inn Rd.	Clarion	PA	Active
DSH390086EU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Diabetes and Nutrition Wellness Center Clearfield 78200	809 Turnpike Ave	Clearfield	PA	Terminated
DSH390086EV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Brookville Rural Health Center 95020	22 Industrial Park Rd	Brookville	PA	Active
DSH390086EW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Punxsy 90940 - Family Medicine	551 W. Mahoning St	Punxsutawney	PA	Terminated
DSH390086EX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Urology St Marys	1100 Million Dollar Highway	St Marys	PA	Terminated
DSH390086EY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopaedics Philipsburg 93310	271 Railroad St	Philipsburg	PA	Terminated
DSH390086EZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Philipsburg 93280	271 Railroad St	Philipsburg	PA	Terminated
DSH390086FA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Residency Clinic 90570	145 Hospital Ave	DuBois	PA	Active
DSH390086FB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Brookville 95550	240 Allegheny Blvd.	Brookville	PA	Terminated
DSH390086FC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands General Surgery Punxsy 90640	551 W. Mahoning St.	Punxsutawney	PA	Terminated
DSH390086FD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center Clarion 94120	1008 S 5th Ave.	Clarion	PA	Terminated
DSH390086FE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine St Marys 94180 - Family Medicine	1100 Million Dollar Hwy	St Marys	PA	Terminated
DSH390086FF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Endocrinology Brookville 90610 - Endocrinology	88 Hospital Road	Brookville	PA	Terminated
DSH390086FG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine Clearfield 90760	815 Doctors Drive	Clearfield	PA	Terminated
DSH390086FH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Interventional Pain Center St Marys 94330	761 Johnsonburg Rd	St Marys	PA	Active
DSH390086FJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Brookville 95590	111 Summit Street	Brookville	PA	Terminated
DSH390086FK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Q Care Clearfield 93420	1900 River Road	Clearfield	PA	Active
DSH390086FL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Brookville Diabetic Clinic 78200 - Diabetic Clinic	100 Hospital Road	Brookville	PA	Terminated
DSH390086FM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurosurgery DuBois	123 Hospital Ave	DuBois	PA	Active
DSH390086FN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurosurgery Clarion	265 Holiday Inn Road	Clarion	PA	Terminated
DSH390086FP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Lung Center Huntingdon 90670 - Lung Center	820 Bryan Street	Huntingdon	PA	Terminated
DSH390086FQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Huntingdon 98010 - Family Medicine	820 Bryan Street	Huntingdon	PA	Terminated
DSH390086FR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Cardiovascular & Thoracic Surgery 90600 - Cardiovascular and Thoracic Surgery	145 Hospital Ave	DuBois	PA	Active
DSH390086FS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics Brookville - Orthopedics	88 Hospital Road	Brookville	PA	Terminated
DSH390086FT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Oncology/Hematology St. Marys - Oncology	1100 Million Dollar Highway	St. Marys	PA	Active
DSH390086FU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Oncology/Hematology Brookville - Oncology	88 Hospital Road	Brookville	PA	Active
DSH390086FV	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Rheumatology	145 Hospital Ave	DuBois	PA	Active
DSH390086FW	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Neurosurgery Huntingdon - Neurosurgery	820 Bryan Street	Huntingdon	PA	Terminated
DSH390086FX	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Endocrinology - Clarion - Endocrinology	265 Holiday Inn Road	Clarion	PA	Terminated
DSH390086FY	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Clearfield Campus Operating Room - Operating Room	809 Turnpike Avenue	Clearfield	PA	Active
DSH390086FZ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Bright Horizons Behavioral Health Services - Clearfield - Psychiatric/Psychological services	1033 Turnpike Ave.	Clearfield	PA	Active
DSH390086GA	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH Familiy Medicine - Hawkins - Family Medicine	761 Johnsonburg Road	Saint Marys	PA	Active
DSH390086GB	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Cardiopulmonary - Clearfield - Cardiopulmonary	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GC	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Clearfield Radiology - Radiology	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GD	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology - Clarion - Gastroenterology	265 Holiday Inn Road	Clarion	PA	Active
DSH390086GE	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Clearfield Campus Cardiac Rehabilitation - Cardiac Rehabilitation	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GF	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Clearfield Campus Recovery Room - Post Op Recovery Room	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GG	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Weight Management/Diabetic Clinic - St Marys - Weight Management/Diabetic Education	1100 Million Dollar Highway	Saint Marys	PA	Terminated
DSH390086GH	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Orthopedics - Clarion - Orthopedics	265 Holiday Inn Road	Clarion	PA	Active
DSH390086GJ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Emergency Department - Clearfield - Emergency Medicine	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GK	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PHD Wound Clinic - Clearfield - Wound Care	809 Turnpike Ave.	Clearfield	PA	Active
DSH390086GL	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH FAM MED/QCARE CLARION - Family Medicine	265 HOLIDAY INN RD	CLARION	PA	Active
DSH390086GM	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH PEDIATRICS DUBOIS - Pediatrics DuBois	123 HOSPITAL AVE	DU BOIS	PA	Active
DSH390086GN	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Orthopedics and Sports Medicine - PH Orthopedics and Sports Med DuBois COE	123 Hospital Ave	DuBois	PA	Active
DSH390086GP	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Life's Journey - PH Life's Journey DuBois	123 Hospital Ave	DuBois	PA	Active
DSH390086GQ	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Integrated Recovery - Integrated Recovery DuBois	635 Maple Ave	DuBois	PA	Active
DSH390086GR	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH Life's Journey - PH Life's Journey Punxsutawney	21911 Route 119	Punxsutawney	PA	Active
DSH390086GS	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH MEDICAL ONCOLOGY PUNXSY - ONCOLOGY	21911 ROUTE 119	PUNXSUTAWNEY	PA	Active
DSH390086GT	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH GASTROENTEROLOGY CLEARFIELD - Gastroenterology	807 Turnpike Ave.	Clearfield	PA	Active
DSH390086GU	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	PH Life's Journey Clarion - OB/GYN	265 Holiday Inn Road	Clarion	PA	Active
DSH390086H	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Brookville 95510	90 Hospital Rd	Brookville	PA	Terminated
DSH390086L	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90500	100 Meadow Lane	DuBois	PA	Active
DSH390086M	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Rheumatology	621 South Main Street	DuBois	PA	Active
DSH390086N	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Infusion Therapy	621 South Main Street	DuBois	PA	Active
DSH390086P	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Reynoldsville 90560	5 North Third Street	Reynoldsville	PA	Active
DSH390086Q	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Cardiovascular/Thoracic Surgery 90600	145 Hospital Ave	DuBois	PA	Active
DSH390086R	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90530	100 Meadow Lane	DuBois	PA	Active
DSH390086S	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Pulmonology and Sleep Medicine DuBois 90810	621 South Main St	DuBois	PA	Active
DSH390086T	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Ophthalmology DuBois 90740	529 Sunflower Drive	DuBois	PA	Active
DSH390086U	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Gastroenterology DuBois	621 South Main Street	DuBois	PA	Active
DSH390086V	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90540	145 Hospital Ave	DuBois	PA	Active
DSH390086W	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine DuBois 90520	145 Hospital Ave	DuBois	PA	Terminated
DSH390086X	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Force 90580	230 Hemlock Avenue	Force	PA	Terminated
DSH390086Y	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Brockway 90510	1200 Wood St	Brockway	PA	Active
DSH390086Z	Child	DSH	DUBOIS REGIONAL MEDICAL CENTER	Penn Highlands Family Medicine Curwensville 93340	465 State St	Curwensville	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/23/2023 7:22:19 AM	8/12/2024 10:40:01 AM	8/12/2024 10:40 AM
Contacts	Authorizing Official	Update	Change Request	Schneider, Heather B System CFO Penn Highlands Healthcare 8143756432	Norman, Mark COO Penn Highlands Healthcare 8143756608	5/2/2024 3:44 PM
Details	Last Recertification Date	Update	Recertification	9/12/2022 4:04:03 PM	8/23/2023 7:22:19 AM	8/23/2023 7:22 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	3/31/2023 12:30 PM
Addresses	Shipping Address	Insert	Change Request		Penn Highlands Family Medicine Residency Clinic 145 Hospital Ave Suite 315 DuBois, PA 15801	11/22/2022 8:18 AM
Addresses	Shipping Address	Insert	Group Change Request		Penn Highlands DuBois Pharmacy 100 Hospital Ave DuBois, PA 15801	11/2/2022 2:32 PM
Details	Last Recertification Date	Update	Recertification	9/8/2021 10:02:10 AM	9/12/2022 4:04:03 PM	9/12/2022 4:04 PM
Contacts	Authorizing Official	Update	AO Change Request	Kline, Brian CFO Penn Highlands DuBois 8143756377	Schneider, Heather B System CFO Penn Highlands Healthcare 8143756432	5/11/2022 7:40 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1861868143 (PA)		3/18/2022 7:51 AM
Details	Last Recertification Date	Update	Recertification	9/8/2020 7:06:15 AM	9/8/2021 10:02:10 AM	9/8/2021 10:02 AM
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
Details	Entity Subname	Update	Change Request	Penn Highlands Family Medicine Continuity Clinic 90570	Penn Highlands Family Medicine Residency Clinic 90570	4/12/2021 12:19 PM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/8/2020 7:06 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/8/2020 7:06 AM
Details	Last Recertification Date	Update	Recertification	9/13/2019 2:42:46 PM	9/8/2020 7:06:15 AM	9/8/2020 7:06 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	5/15/2020 1:15 PM
Details	Last Recertification Date	Update	Recertification	8/24/2018 6:53:37 AM	9/13/2019 2:42:46 PM	9/13/2019 2:42 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1144249657	5/9/2019 1:29 PM
Details	Entity Subname	Update	Change Request	Penn Highlands Family Medicine Continuity Clinic 94150	Penn Highlands Family Medicine Continuity Clinic 90570	5/9/2019 1:29 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	10/17/2018 9:10 AM
Details	Last Recertification Date	Update	Recertification		8/24/2018 6:53:37 AM	8/24/2018 6:53 AM
Details	Entity Subname	Update	Change Request	Penn Highlands Family Medicine Continuity Clinic 95020	Penn Highlands Family Medicine Continuity Clinic 94150	7/16/2018 8:38 AM
Details	Entity Subname	Update	Change Request	Penn Highlands Family Medicine Continuity Clinic 94150 - Family Medicine	Penn Highlands Family Medicine Continuity Clinic 95020	6/12/2018 7:21 AM
Details	State	Update	Change Request	Approved	Active	6/12/2018 7:21 AM
Contacts	Signed By	Insert	New Registration		Kline, Brian CFO Penn Highlands DuBois 8143756377	5/14/2018 9:53 AM
Details	340B ID	Update	New Registration		DSH390086FA	5/14/2018 9:53 AM
Details	Entity Subname	Update	New Registration	Penn Highlands Family Medicine Continuity Clinic 94150	Penn Highlands Family Medicine Continuity Clinic 94150 - Family Medicine	5/14/2018 9:53 AM
Dates	Participating Approval Date	Update	New Registration		5/14/2018 9:53:04 AM	5/14/2018 9:53 AM
Details	State	Update	New Registration	Pending	Approved	5/14/2018 9:53 AM
Dates	Signed By Date	Update	New Registration		4/12/2018 1:03:39 PM	5/14/2018 9:53 AM
Dates	Start Date	Update	New Registration		7/1/2018 12:00:00 AM	5/14/2018 9:53 AM
Addresses	Main Address	Insert	New Registration		145 Hospital Ave Suite 315 DuBois, PA 15801	4/12/2018 11:45 AM
Addresses	Billing Address	Insert	New Registration		Penn Highlands DuBois 100 Hospital Ave PO Box 447 DuBois, PA 15801	4/12/2018 11:45 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2018 11:45 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007740880225	4/12/2018 11:45 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/12/2018 11:45 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1861868143	4/12/2018 11:45 AM
Contacts	Primary Contact	Insert	New Registration		Strini, Jessica 340B Coordinator Penn Highlands Healthcare 8143756553	4/12/2018 11:45 AM
Contacts	Authorizing Official	Insert	New Registration		Kline, Brian CFO Penn Highlands DuBois 8143756377	4/12/2018 11:45 AM
Details	Last Recertification Date	Insert	New Registration			4/12/2018 11:45 AM
Details	Grant Number	Insert	New Registration			4/12/2018 11:45 AM
Details	340B ID	Insert	New Registration			4/12/2018 11:45 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2018 11:45 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2018 11:45 AM
Details	Medicare Provider Number	Insert	New Registration		390086	4/12/2018 11:45 AM
Details	Entity Name	Insert	New Registration		DUBOIS REGIONAL MEDICAL CENTER	4/12/2018 11:45 AM
Details	Program Code	Insert	New Registration		DSH	4/12/2018 11:45 AM
Details	Entity Subname	Insert	New Registration		Penn Highlands Family Medicine Continuity Clinic 94150	4/12/2018 11:45 AM
Dates	Participating Approval Date	Insert	New Registration			4/12/2018 11:45 AM
Details	State	Insert	New Registration		Pending	4/12/2018 11:45 AM
Dates	Registration Date	Insert	New Registration		4/12/2018 11:45:07 AM	4/12/2018 11:45 AM
Dates	Signed By Date	Insert	New Registration			4/12/2018 11:45 AM
Dates	Start Date	Insert	New Registration			4/12/2018 11:45 AM
Terminations	Termination Comments	Insert	New Registration			4/12/2018 11:45 AM
Terminations	Termination Date	Insert	New Registration			4/12/2018 11:45 AM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2018 11:45 AM
Terminations	Termination Reason	Insert	New Registration			4/12/2018 11:45 AM