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PENNSYLVANIA CVS PHARMACY, L.L.C.
CAH391309-00 Barnes Kasson County Hospital
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Covered Entity Details
Entity Name
Barnes Kasson County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391309-00
Entity Address
2872 Turnpike Street
Susquehanna, PA 18847
Medicare Provider Number
391309
Participating Start Date
10/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
CVS/PHARMACY #11422
177 ERIE BLVD
SUSQUEHANNA, PA 18847-2791
Pharmacy Comments
Contract Details
Approval Date
3/20/2020
Contract Begin Date
3/20/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Dave Passetti, Administrator
(570) 853-3135 Ext: 487
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
3/20/2020
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