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CAH391313-11 CHARLES COLE MEMORIAL HOSPITAL (Active)
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Main Details
Name
CHARLES COLE MEMORIAL HOSPITAL
Subdivision Name
Oncology - Medical Oncology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH391313-11
Medicare Provider Number
391313
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/15/2020
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
Jessica St.Onge, 340B Manager
(302) 943-1813
Addresses
Street Address
39 Memorial Drive
Coudersport, PA 16915
Billing Address
Charles Cole Memorial Hospital
1001 East Second Street
Coudersport, PA 16915
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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