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CAH391313-00 CHARLES COLE MEMORIAL HOSPITAL (Active)
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Main Details
Name
CHARLES COLE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH391313-00
Medicare Provider Number
391313
Additional Details
Current Program Status
Active
Registration Date
8/17/2010
Participating Start Date
8/25/2010
Participating Approval Date
8/17/2010
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
UPMC Susquehanna
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175
Primary Contact
UPMC
Jessica St.Onge, 340B Manager
(302) 943-1813
Addresses
Street Address
1001 EAST 2ND STREET
COUDERSPORT, PA 16915
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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10/29/2010- UPDATED MEDICAID INFO.(WAS 100001127-0109 AND NPI- 1417919945)
10/29/2010
April 2025
April 2025
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