340B Drug Pricing Program Database
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DSH390086FG DUBOIS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
Penn Highlands Orthopedics and Sports Medicine Clearfield 90760
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390086FG
Medicare Provider Number
390086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/23/2019
Last Recertification Date
8/12/2024
Termination Date
Termination Reason
4/1/2025
Business decision by the Covered Entity
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
815 Doctors Drive
Clearfield, PA 16830
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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