340B Drug Pricing Program Database
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CAH391316-02 WELLSBORO (Active)
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Main Details
Name
WELLSBORO
Subdivision Name
OFFICE OF INTERAL MEDICINE A DEPT - INTERNAL MEDICINE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH391316-02
Medicare Provider Number
391316
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/15/2020
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
UPMC Susquehanna
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175
Primary Contact
UPMC
Anna V. Michalak, 340B Manager
(704) 438-7126
Addresses
Street Address
103 WEST AVE
STE 203
WELLSBORO, PA 16901-1358
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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