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DSH390118 BRADFORD REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
BRADFORD REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390118
Medicare Provider Number
390118
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2005
Participating Start Date
7/1/2005
Participating Approval Date
6/15/2005
Last Recertification Date
11/6/2017
Termination Date
Termination Reason
4/1/2018
Other
Contacts
Authorizing Official
Bradford Regional Medical Center
Richard G. Braun Jr., SVP Finance and CFO
(716) 375-6190
Primary Contact
Bradford Regional Medical Center
TOM KREINER, PHARMACY MANGER
(814) 362-8222
Addresses
Street Address
116-56 INTERSTATE PARKWAY
BRADFORD, PA 16701
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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04/13/11, UPDATED ADDR.(116 INTERSTATE PARKWAY)
04/13/2011
April 2025
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