340B Drug Pricing Program Database


CAH391313-11 CHARLES COLE MEMORIAL HOSPITAL (Active) - information as of 6/3/2025 10:54:51 AM

Main Details
CHARLES COLE MEMORIAL HOSPITAL
Oncology - Medical Oncology
Critical Access Hospital
Yes
CAH391313-11
391313


Additional Details
Active
4/14/2020
7/1/2020
4/15/2020
9/4/2024

Contacts

UPMC Susquehanna
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175

UPMC
Jessica St.Onge, 340B Manager
(302) 943-1813

Addresses

39 Memorial Drive
Coudersport, PA 16915

UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain
PO Box 2058
Portland, OR 97208


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA100001127,0010212201326161662,1487616470,1992729305,1619008554,1114195666,1164406401,1083632657,1013937457,1033283437,1164594495,1275605750,1003988502,1275605776,1629191358,1407928757,1427129139,1861564106
Shipping Addresses

UPMC CANCER CENTER PHARMACY COLE
39 MEMORIAL DRIVE
ROOM 116
COUDERSPORT, PA 16915

HC PHARMACY CENTRAL
3175 E CARSON ST
PITTSBURGH, PA 15203

UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain
3175 E Carson St
Pittsburgh, PA 15203
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH391313-01ChildCAHCHARLES COLE MEMORIAL HOSPITALCOUDERSPORT FAMILY MEDICINE1001 EAST 2ND STREETCOUDERSPORTPAActive
CAH391313-02ChildCAHCHARLES COLE MEMORIAL HOSPITALELDRED HEALTH CENTER139 MAIN STREETELDREDPAActive
CAH391313-03ChildCAHCHARLES COLE MEMORIAL HOSPITALEMPORIUM HEALTH CENTER288 SIZERVILLE ROADEMPORIUMPAActive
CAH391313-04ChildCAHCHARLES COLE MEMORIAL HOSPITALGALETON HEALTH CENTER30 RIVER STREETGALETONPAActive
CAH391313-05ChildCAHCHARLES COLE MEMORIAL HOSPITALPORT ALLEGANY HEALTH CENTER45 PINE STREETPORT ALLEGANYPAActive
CAH391313-06ChildCAHCHARLES COLE MEMORIAL HOSPITALSHINGLEHOUSE HEALTH CENTER129 N Puritan StreetSHINGLEHOUSEPAActive
CAH391313-07ChildCAHCHARLES COLE MEMORIAL HOSPITALNORTHERN POTTER HEALTH CENTER511 ACADEMY ST.ULYSSESPAActive
CAH391313-08ChildCAHCHARLES COLE MEMORIAL HOSPITALWESTFIELD HEALTH CENTER222 CHURCH STREETWESTFIELDPAActive
CAH391313-09ChildCAHCHARLES COLE MEMORIAL HOSPITALBOWMAN HEALTH CENTER83 S MARVIN STREETSMETHPORTPAActive
CAH391313-10ChildCAHCHARLES COLE MEMORIAL HOSPITALCENTRAL POTTER HEALTH CENTER71 ELK STREETCOUDERSPORTPAActive
CAH391313-11ChildCAHCHARLES COLE MEMORIAL HOSPITALOncology - Medical Oncology39 Memorial DriveCoudersportPAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesBilling AddressUpdateGroup Change RequestCharles Cole Memorial Hospital 1001 East Second Street Coudersport, PA 16915UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain PO Box 2058 Portland, OR 972085/15/2025 1:43 PM
AddressesShipping AddressInsertGroup Change Request UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain 3175 E Carson St Pittsburgh, PA 152035/15/2025 1:43 PM
ContactsPrimary ContactUpdatePC Change RequestMalacarne PharmD, Dr Gary E Director of Pharmacy UPMC Cole 8142605314St.Onge, Jessica 340B Manager UPMC 30294318133/5/2025 6:04 AM
DetailsLast Recertification DateUpdateRecertification8/24/2023 11:32:46 AM9/4/2024 11:25:05 AM9/4/2024 11:25 AM
AddressesShipping AddressInsertChange Request UPMC CANCER CENTER PHARMACY COLE 39 MEMORIAL DRIVE ROOM 116 COUDERSPORT, PA 169152/21/2024 11:01 AM
AddressesShipping AddressInsertChange Request HC PHARMACY CENTRAL 3175 E CARSON ST PITTSBURGH, PA 152032/21/2024 11:01 AM
DetailsLast Recertification DateUpdateRecertification9/1/2022 3:45:10 PM8/24/2023 11:32:46 AM8/24/2023 11:32 AM
ContactsAuthorizing OfficialUpdateAO Change RequestRapp, Ron CFO UPMC Cole 8142605250Yost, Roger C CFO, North-Central PA Region UPMC Susquehanna 57032131755/22/2023 6:29 AM
DetailsLast Recertification DateUpdateRecertification9/9/2021 9:20:07 AM9/1/2022 3:45:10 PM9/1/2022 3:45 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/23/2022 10:22 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 1000011278/23/2022 10:22 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/23/2022 10:22 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 0010212208/23/2022 10:22 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 13261616628/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 14876164708/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 19927293058/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16190085548/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 11141956668/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 11644064018/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10836326578/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10139374578/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10332834378/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 11645944958/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 12756057508/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 10039885028/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 12756057768/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16291913588/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 14079287578/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 14271291398/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 18615641068/23/2022 10:22 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA8/23/2022 10:22 AM
DetailsLast Recertification DateUpdateRecertification8/28/2020 9:44:16 AM9/9/2021 9:20:07 AM9/9/2021 9:20 AM
ContactsAuthorizing OfficialUpdateProfile Change RequestRapp, Ron VP of Finance UPMC Cole 8142605250Rapp, Ron CFO UPMC Cole 81426052503/3/2021 9:53 AM
ContactsSigned ByUpdateProfile Change RequestRapp, Ron VP of Finance UPMC Cole 8142605250Rapp, Ron CFO UPMC Cole 81426052503/3/2021 9:53 AM
DetailsLast Recertification DateUpdateRecertification 8/28/2020 9:44:16 AM8/28/2020 9:44 AM
DetailsStateUpdate ApprovedActive7/1/2020 12:00 AM
ContactsSigned ByInsertNew Registration Rapp, Ron VP of Finance UPMC Cole 81426052504/15/2020 10:50 AM
Details340B IDUpdateNew Registration CAH391313-114/15/2020 10:50 AM
DetailsEntity SubnameUpdateNew RegistrationOncologyOncology - Medical Oncology4/15/2020 10:50 AM
DatesParticipating Approval DateUpdateNew Registration 4/15/2020 10:50:44 AM4/15/2020 10:50 AM
DetailsStateUpdateNew RegistrationPendingApproved4/15/2020 10:50 AM
DatesSigned By DateUpdateNew Registration 4/14/2020 1:17:25 PM4/15/2020 10:50 AM
DatesStart DateUpdateNew Registration 7/1/2020 12:00:00 AM4/15/2020 10:50 AM
AddressesMain AddressInsertNew Registration  39 Memorial Drive Coudersport, PA 169154/14/2020 1:17 PM
AddressesBilling AddressInsertNew Registration Charles Cole Memorial Hospital 1001 East Second Street Coudersport, PA 169154/14/2020 1:17 PM
ContactsAuthorizing OfficialInsertNew Registration Rapp, Ron VP of Finance UPMC Cole 81426052504/14/2020 1:17 PM
ContactsPrimary ContactInsertNew Registration Malacarne PharmD, Dr Gary E Director of Pharmacy UPMC Cole 81426053144/14/2020 1:17 PM
DetailsLast Recertification DateInsertNew Registration  4/14/2020 1:17 PM
DetailsGrant NumberInsertNew Registration  4/14/2020 1:17 PM
Details340B IDInsertNew Registration  4/14/2020 1:17 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/14/2020 1:17 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/14/2020 1:17 PM
DetailsMedicare Provider NumberInsertNew Registration 3913134/14/2020 1:17 PM
DetailsEntity NameInsertNew Registration CHARLES COLE MEMORIAL HOSPITAL4/14/2020 1:17 PM
DetailsProgram CodeInsertNew Registration CAH4/14/2020 1:17 PM
DetailsEntity SubnameInsertNew Registration Oncology4/14/2020 1:17 PM
DatesParticipating Approval DateInsertNew Registration  4/14/2020 1:17 PM
DetailsStateInsertNew Registration Pending4/14/2020 1:17 PM
DatesRegistration DateInsertNew Registration 4/14/2020 1:17:19 PM4/14/2020 1:17 PM
DatesSigned By DateInsertNew Registration  4/14/2020 1:17 PM
DatesStart DateInsertNew Registration  4/14/2020 1:17 PM
TerminationsTermination CommentsInsertNew Registration  4/14/2020 1:17 PM
TerminationsTermination DateInsertNew Registration  4/14/2020 1:17 PM
TerminationsTermination Effective DateInsertNew Registration  4/14/2020 1:17 PM
TerminationsTermination ReasonInsertNew Registration  4/14/2020 1:17 PM