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DSH390086AU DUBOIS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
Penn Highlands Infectious Disease 90660
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390086AU
Medicare Provider Number
390086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/12/2024
Participating Start Date
4/1/2024
Participating Approval Date
3/12/2024
Last Recertification Date
8/12/2024
Termination Date
Termination Reason
1/1/2025
Site closure
Contacts
Authorizing Official
Penn Highlands Healthcare
Mark Norman, COO
(814) 375-6608
Primary Contact
Penn Highlands Healthcare
Mike Pasternak, 340B Compliance Manager
(814) 375-6139
Addresses
Street Address
635 Maple Ave
DuBois, PA 15801
Billing Address
Penn Highlands DuBois
100 Hospital Ave
Business Office
DuBois, PA 15801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 1/1/2013, terminated 4/1/2016. Reinstated 4/1/2024.
03/12/2024
April 2025
April 2025
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