340B Drug Pricing Program Database
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CAH391316-07 WELLSBORO (Active)
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Main Details
Name
WELLSBORO
Subdivision Name
SUSSH-MEDICAL ONCOLOGY - - (33309)
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH391316-07
Medicare Provider Number
391316
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2022
Participating Start Date
1/1/2023
Participating Approval Date
11/4/2022
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
15 Meade St
Suite L-3
Wellsboro, PA 16901
Billing Address
UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain
PO Box 2058
Portland, OR 97208
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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