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GAUGHN'S DRUG STORE
DSH390146 WARREN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
WARREN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390146
Entity Address
2 CRESCENT PARK WEST
WARREN, PA 16365
Medicare Provider Number
390146
Participating Start Date
1/1/2019
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
GAUGHN'S DRUG STORE
Pharmacy Address
GAUGHN'S DRUG STORE
348 PENNSYLVANIA AVE WEST
WARREN, PA 16365
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Louis Longo, Chief Financial Officer
(814) 573-2211 Ext: 2308
Contract Pharmacy Representative
Gaughn's Drug Store
Scott Newton, President/Owner
(814) 723-2840
Signed By Date
1/11/2019
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