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GAUGHN'S DRUG STORE
CAH391313-00 CHARLES COLE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHARLES COLE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391313-00
Entity Address
1001 EAST 2ND STREET
COUDERSPORT, PA 16915
Medicare Provider Number
391313
Participating Start Date
8/25/2010
Last Recertification Date
9/4/2024
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
7/8/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/3/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Ron Rapp, CFO
(814) 260-5250
Contract Pharmacy Representative
Gaughn's Drug Store
Scott Newton, President/Owner
(814) 723-2840
Signed By Date
7/8/2020
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