340B Drug Pricing Program Database
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DSH390086GG DUBOIS REGIONAL MEDICAL CENTER (Terminated)
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Main Details
Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
Weight Management/Diabetic Clinic - St Marys - Weight Management/Diabetic Education
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390086GG
Medicare Provider Number
390086
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/5/2023
Participating Start Date
7/1/2023
Participating Approval Date
4/5/2023
Last Recertification Date
8/12/2024
Termination Date
Termination Reason
1/1/2025
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
1100 Million Dollar Highway
Suite 3
Saint Marys, PA 15857
Billing Address
DuBois Regional Medical Center
100 Hospital Ave.
PO Box 447
DuBois, PA 15801
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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