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DSH390086CT DUBOIS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
Penn Highlands Pediatrics Brookville 90720
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390086CT
Medicare Provider Number
390086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/5/2015
Last Recertification Date
Termination Date
Termination Reason
7/1/2015
For-Profit conversion
Contacts
Authorizing Official
Penn Highlands DuBois
Brian Kline, CFO
(814) 375-6377
Primary Contact
Lauri Schall, 340B Coordinator
(814) 375-3762
Addresses
Street Address
2834 Maplevale Rd
Brookville, PA 15825
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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