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DSH390086CC DUBOIS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
Penn Highlands Family Medicine DuBois 90570
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390086CC
Medicare Provider Number
390086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/6/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/5/2015
Last Recertification Date
8/23/2018
Termination Date
Termination Reason
10/1/2019
Other
Contacts
Authorizing Official
Penn Highlands DuBois
Brian Kline, CFO
(814) 375-6377
Primary Contact
Penn Highlands Healthcare
Jennifer Miller, 340B Coordinator
(814) 375-6625
Addresses
Street Address
145 Hospital Ave
Suite 106
DUBOIS, PA 15801
Billing Address
Penn Highlands DuBois
100 Hospital Ave
PO Box 447
DuBois, PA 15801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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