340B Drug Pricing Program Database


CAH391313-11 CHARLES COLE MEMORIAL HOSPITAL (Active) - information as of 4/27/2025 12:51:11 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

Charles Cole Memorial Hospital
1001 East Second Street
Coudersport, PA 16915


  • 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
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 
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