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GIANT EAGLE PHARMACY #0095
CAH391314-00 TITUSVILLE AREA HOSPITAL
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Covered Entity Details
Entity Name
TITUSVILLE AREA HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391314-00
Entity Address
406 WEST OAK STREET
TITUSVILLE, PA 16354
Medicare Provider Number
391314
Participating Start Date
7/1/2015
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #0095
Pharmacy Address
18511 SMOCK HIGHWAY
MEADVILLE, PA 16335
Pharmacy Comments
Contract Details
Approval Date
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JILL NEELY, CFO
(814) 827-1851
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
10/15/2019
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