340B Drug Pricing Program Database
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DSH390113M Meadville Medical Center (Terminated)
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Main Details
Name
Meadville Medical Center
Subdivision Name
CONNEAUT LAKE HEALTH CENTER
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390113M
Medicare Provider Number
390113
Outpatient Facility Provider Number
393431
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/22/2017
Last Recertification Date
9/5/2018
Termination Date
Termination Reason
7/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Meadville Medical Center
Ellie Jo Amory, 340B Program Administrator
(814) 333-5669
Primary Contact
Meadville Medical Center
Sandra J. Clark, 340B Coordinator
(814) 373-2244
Addresses
Street Address
10926 HIGHWAY 18
CONNEAUT LAKE HEALTH CENTER
CONNEAUT LAKE, PA 16316-3526
Billing Address
Meadville Medical Center
1034 Grove Street
Meadville, PA 16335
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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