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DSH390086FD DUBOIS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
Penn Highlands Interventional Pain Center Clarion 94120
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390086FD
Medicare Provider Number
390086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/31/2018
Last Recertification Date
9/8/2021
Termination Date
Termination Reason
4/1/2022
Site closure
Contacts
Authorizing Official
Penn Highlands DuBois
Brian Kline, CFO
(814) 375-6377
Primary Contact
Penn Highlands Healthcare
Bailey Voelker, 340B Coordinator
(814) 375-6625
Addresses
Street Address
1008 S 5th Ave.
Suite 102
Clarion, PA 16214
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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What is the reason for the address change? Is the same service being provided at the new address. Please respond in the comment section and return. If this is returned unanswered the request will be rejected. Thank you.
03/27/2020
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