Covered Entity Details

CH030220K Broad Top Area Medical Center, Inc., The (Active) - information as of 5/17/2025 10:55:05 PM

Main Details

Name

Broad Top Area Medical Center, Inc., The

Subdivision Name

BTAMC INC FAMILY WELLNESS CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-038867

340B ID

CH030220K

Grant Number

H80CS00330

Additional Details

Current Program Status

Active

Registration Date

1/13/2021

Participating Start Date

4/1/2021

Participating Approval Date

1/22/2021

Last Recertification Date

2/19/2025

Contacts

Authorizing Official

Broad Top Area Medical Center, Inc.
John Roth, CEO
(814) 635-7351

Primary Contact

Broad Top Medical Center, Inc
Rita Hollibaugh, 340B Coordinator / Patient Access Programs Director
(814) 907-3400 Ext: 2209

Addresses

Street Address

419 14th Street
Huntingdon, PA 16652-1937

Billing Address

BROAD TOP AREA MEDICAL CENTER, INC.
4133 MEDICAL CENTER DRIVE
BROAD TOP, PA 16621-9001

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	07/14/2024	10/01/2024	10/01/2024
Contract Detail	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	04/11/2025	07/01/2025	04/11/2025
Contract Detail	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	04/11/2025	07/01/2025	04/11/2025
Contract Detail	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	04/11/2025	07/01/2025	04/11/2025
Contract Detail	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	04/11/2025	07/01/2025	04/11/2025
Contract Detail	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	04/11/2025	07/01/2025	04/11/2025
Contract Detail	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	07/14/2024	10/01/2024	10/01/2024
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	07/14/2024	10/01/2024	10/01/2024
Contract Detail	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	07/14/2024	10/01/2024	10/01/2024
Contract Detail	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	07/14/2024	10/01/2024	01/23/2025

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH030220	Terminated	Admin	BROAD TOP AREA MEDICAL CENTER		RT 913	BROAD TOP	PA
CH030220A	Terminated	BPS-H80-012429	BROAD TOP AREA MEDICAL CENTER	Broad Top Area Medical Center At Huntingdon	909 Moore St	Huntingdon	PA
CH030220B	Active	BPS-H80-018437	BROAD TOP AREA MEDICAL CENTER, INC.	Broad Top Area Medical Center Primary Care Center	790 Bryan Street, Suite 1	Huntingdon	PA
CH030220C	Terminated	BPS-H80-018438	BROAD TOP AREA MEDICAL CENTER, INC., THE	Broad Top Area Medical Center Pediatric / Women's Care Center	1225 Warm Springs Ave.	Huntingdon	PA
CH030220D	Terminated	BPS-H80-018364	BROAD TOP AREA MEDICAL CENTER, INC.	Broad Top Area Medical Center Trough Creek	478 Seminary Street	Cassville	PA
CH030220E	Active	BPS-H80-018280	BROAD TOP AREA MEDICAL CENTER, INC.	Broad Top Area Medical Center Family Care Center	835 Washington Street	Huntingdon	PA
CH030220F	Active	BPS-H80-000988	BROAD TOP AREA MEDICAL CENTER, INC.	BROAD TOP AREA MEDICAL CENTER, INC.	4133 MEDICAL CENTER DRIVE	BROAD TOP	PA
CH030220G	Active	BPS-H80-021254	Broad Top Area Medical Center, Inc., The	Broad Top Area Medical Center Mount Union	95 S. Park St.	Mount Union	PA
CH030220H	Active	BPS-H80-027329	Broad Top Area Medical Center, Inc.	Broad Top Area Medical Center Walk in Clinic	6678 Towne Center Blvd.	Huntingdon	PA
CH030220J	Active	BPS-H80-037057	Broad Top Area Medical Center, Inc.,	BTAMC Pediatric & Family Healthcare	6311 Margy Drive	Huntingdon	PA
CH030220K	Active	BPS-H80-038867	Broad Top Area Medical Center, Inc., The	BTAMC INC FAMILY WELLNESS CENTER	419 14th Street	Huntingdon	PA
CH030220L	Active	BPS-H80-032769	Broad Top Area Medical Center, Inc., The	BTAMC Belleville Wellness Center	375 S Kishacoquillas St	Belleville	PA
CH030220M	Active	BPS-H80-032941	Broad Top Area Medical Center, Inc., The	BTAMC Southern Huntingdon County Medical Center	626 Water St Ste 1	Orbisonia	PA
CH030220N	Active	BPS-H80-032543	Broad Top Area Medical Center, Inc., The	Broad Top Area Medical Center INC	358 Seminary St	Cassville	PA
CH030220P	Active	BPS-H80-035258	Broad Top Area Medical Center, Inc., The	BTAMC, Inc. SHCMC Dental Clinic	626 Water Street STE 2	Orbisonia	PA
CH030220Q	Active	BPS-H80-035491	Broad Top Area Medical Center, Inc., The	Juniata Valley BTAMC Clinic	846 Medical Center, Drive	Alexandria	PA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH030220	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2016	10/01/2020
CH030220F	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	07/13/2020
CH030220J	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220E	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220P	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220G	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220N	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220Q	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220K	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220L	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220H	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220B	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220M	APPLEBY'S DRUG STORE	133 E. SHIRLEY ST.		MOUNT UNION	PA	17066	10/01/2024
CH030220J	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220N	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220M	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220H	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220K	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220Q	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220G	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220P	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220F	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220E	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220L	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220B	GIANT PHARMACY #6277	7673 LAKE RAYSTOWN SHOPPING	CENTER	HUNTINGDON	PA	16652	07/01/2025
CH030220J	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220Q	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220B	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220N	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220E	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220M	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220L	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220G	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220F	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220K	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220H	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220P	MARTIN'S PHARMACY #6012	2032 EAST PLEASANT VALLEY BLVD		ALTOONA	PA	16602-7515	07/01/2025
CH030220L	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220J	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220N	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220H	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220P	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220B	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220F	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220M	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220E	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220G	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220Q	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220K	MARTIN'S PHARMACY #6288	221 GLIMCHER DR		DUNCANSVILLE	PA	16635	07/01/2025
CH030220M	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220J	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220F	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220E	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220L	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220B	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220H	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220Q	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220G	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220P	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220N	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220K	MARTIN'S PHARMACY #6292	200 E. CHESTNUT AVENUE		ALTOONA	PA	16601	07/01/2025
CH030220E	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220K	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220Q	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220P	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220L	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220B	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220G	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220N	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220F	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220M	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220J	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220H	MARTIN'S PHARMACY #6466	GIANT FOOD STORES, LLC	1000 LOGAN BOULEVARD, SUITE 108	ALTOONA	PA	16602	07/01/2025
CH030220	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	07/01/2018	10/01/2020
CH030220F	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	07/13/2020
CH030220G	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220B	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220J	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220H	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220E	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220L	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220M	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220K	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220Q	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220N	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220P	ORBY PHARMACY INC	SOUTHERN HUNTINGDON MEDICAL	626 WATER ST STE 3 PO BOX 367	ORBISONIA	PA	17243	10/01/2024
CH030220	PAUL B MACDONALDS PHARMACY INC	214 PEACH ORCHARD RD STE 100		MC CONNELLSBURG	PA	17233	10/01/2016	12/05/2018
CH030220	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	01/01/2016	10/01/2020
CH030220F	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	07/13/2020
CH030220L	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220K	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220N	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220E	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220H	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220J	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220B	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220P	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220M	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220Q	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220G	RITE AID OF PENNSYLVANIA, LLC	RITE AID #233	9635 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	16652	10/01/2024
CH030220F	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2020
CH030220G	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220M	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220J	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220E	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220K	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220P	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220N	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220B	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220Q	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220H	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220L	RUBY'S PHARMACY INC.	509 MAIN ST STE 102		SAXTON	PA	16678-1050	10/01/2024
CH030220	SAXTON STATION PHARMACY	509 MAIN STREET	SUITE 102	SAXTON	PA	16678	05/03/2013	09/30/2015
CH030220	THE MEDICINE SHOPPE	730 WASHINGTON ST		HUNTINGDON	PA	16652	04/01/2016	10/01/2020
CH030220A	THE MEDICINE SHOPPE	730 WASHINGTON ST		HUNTINGDON	PA	16652	11/01/2010	04/01/2017
CH030220F	THE MEDICINE SHOPPE	730 WASHINGTON ST		HUNTINGDON	PA	16652	07/13/2020	07/01/2024
CH030220	WAL-MART PHARMACY 10-5470	6716 TOWN CENTER BLVD		HUNTINGDON	PA	16652	04/13/2012	02/24/2017
CH030220	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2016	10/01/2020
CH030220F	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	07/13/2020
CH030220B	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220M	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220J	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220G	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220Q	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220K	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220H	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220P	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220N	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220L	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024
CH030220E	WEIS PHARMACY #30	611 15TH ST		HUNTINGDON	PA	16652	10/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/23/2024 10:25:58 AM	2/19/2025 11:49:05 AM	2/19/2025 11:49 AM
Contacts	Primary Contact	Update	Profile Change Request	Hollibaugh, Rita 340B Coordinator / Patient Access Programs Director Broad Top Medical Center, Inc 8146438448	Hollibaugh, Rita 340B Coordinator / Patient Access Programs Director Broad Top Medical Center, Inc 8149073400-2209	12/2/2024 5:46 PM
Addresses	Billing Address	Insert	Change Request		BROAD TOP AREA MEDICAL CENTER, INC. 4133 MEDICAL CENTER DRIVE BROAD TOP, PA 16621-9001	9/11/2024 2:41 PM
Addresses	Main Address	Update	Change Request	814 Washington St Huntingdon, PA 16652-1726	419 14th Street Huntingdon, PA 16652-1937	8/22/2024 11:57 AM
Contacts	Primary Contact	Update	Profile Change Request	Hollibaugh, Rita 340B Coordinator / Outreach & Enrollment Director Broad Top Medical Center, Inc 8146438448	Hollibaugh, Rita 340B Coordinator / Patient Access Programs Director Broad Top Medical Center, Inc 8146438448	8/20/2024 9:43 AM
Details	Last Recertification Date	Update	Recertification	2/14/2023 4:25:46 PM	2/23/2024 10:25:58 AM	2/23/2024 10:25 AM
Details	Last Recertification Date	Update	Recertification	2/17/2022 1:53:45 PM	2/14/2023 4:25:46 PM	2/14/2023 4:25 PM
Details	Last Recertification Date	Update	Recertification		2/17/2022 1:53:45 PM	2/17/2022 1:53 PM
Details	State	Update		Approved	Active	4/1/2021 12:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Hollibaugh, Rita Practice Administration Broad Top Medical Center, Inc 8146438448	Hollibaugh, Rita 340B Coordinator / Outreach & Enrollment Director Broad Top Medical Center, Inc 8146438448	2/18/2021 5:56 PM
Contacts	Signed By	Insert	New Registration		Roth, John CEO Broad Top Area Medical Center, Inc. 8146357351	1/22/2021 9:33 AM
Details	340B ID	Update	New Registration		CH030220K	1/22/2021 9:33 AM
Dates	Participating Approval Date	Update	New Registration		1/22/2021 9:33:12 AM	1/22/2021 9:33 AM
Details	State	Update	New Registration	Pending	Approved	1/22/2021 9:33 AM
Dates	Signed By Date	Update	New Registration		1/13/2021 10:23:41 PM	1/22/2021 9:33 AM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	1/22/2021 9:33 AM
Addresses	Main Address	Insert	New Registration		814 Washington St Huntingdon, PA 16652-1726	1/13/2021 5:27 PM
Addresses	Billing Address	Insert	New Registration		Broad Top Area Medical Center, Inc. - Wellness Ctr. 4133 Medical Center Drive Broad Top, PA 16621-9001	1/13/2021 5:27 PM
Contacts	Primary Contact	Insert	New Registration		Hollibaugh, Rita Practice Administration Broad Top Medical Center, Inc 8146438448	1/13/2021 5:27 PM
Contacts	Authorizing Official	Insert	New Registration		Roth, John CEO Broad Top Area Medical Center, Inc. 8146357351	1/13/2021 5:27 PM
Details	Assistance Received From Date	Insert	New Registration			1/13/2021 5:27 PM
Details	Assistance Received To Date	Insert	New Registration			1/13/2021 5:27 PM
Details	Last Recertification Date	Insert	New Registration			1/13/2021 5:27 PM
Details	Grant Number	Insert	New Registration		H80CS00330	1/13/2021 5:27 PM
Details	340B ID	Insert	New Registration			1/13/2021 5:27 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/13/2021 5:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/13/2021 5:27 PM
Details	Medicare Provider Number	Insert	New Registration			1/13/2021 5:27 PM
Details	Entity Name	Insert	New Registration		Broad Top Area Medical Center, Inc., The	1/13/2021 5:27 PM
Details	NOFO Number	Insert	New Registration			1/13/2021 5:27 PM
Details	Program Code	Insert	New Registration		CH	1/13/2021 5:27 PM
Details	Entity Subname	Insert	New Registration		BTAMC INC FAMILY WELLNESS CENTER	1/13/2021 5:27 PM
Dates	Participating Approval Date	Insert	New Registration			1/13/2021 5:27 PM
Details	State	Insert	New Registration		Pending	1/13/2021 5:27 PM
Dates	Registration Date	Insert	New Registration		1/13/2021 5:27:29 PM	1/13/2021 5:27 PM
Dates	Signed By Date	Insert	New Registration			1/13/2021 5:27 PM
Dates	Start Date	Insert	New Registration			1/13/2021 5:27 PM
Terminations	Termination Comments	Insert	New Registration			1/13/2021 5:27 PM
Terminations	Termination Date	Insert	New Registration			1/13/2021 5:27 PM
Terminations	Termination Effective Date	Insert	New Registration			1/13/2021 5:27 PM
Terminations	Termination Reason	Insert	New Registration			1/13/2021 5:27 PM

340B Drug Pricing Program Database