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BUCHANAN BROTHERS PHARMACY
CAH391316-00 WELLSBORO
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Covered Entity Details
Entity Name
WELLSBORO
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391316-00
Entity Address
32-36 CENTRAL AVENUE
WELLSBORO, PA 16901
Medicare Provider Number
391316
Participating Start Date
4/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
BUCHANAN BROTHERS PHARMACY
Pharmacy Address
122 W MAIN ST
WESTFIELD, PA 16950-1522
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Stockhausen, CFO
(412) 664-2528
Contract Pharmacy Representative
Buchanan Brothers Pharmacy
Joseph Marzo, Pharmacist-POC
(814) 367-2327
Signed By Date
1/13/2020
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