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KLINGENSMITH'S DRUG STORE
DSH390163 ARMSTRONG COUNTY MEMORIAL
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Covered Entity Details
Entity Name
ARMSTRONG COUNTY MEMORIAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390163
Entity Address
ONE NOLTE DRIVE
KITTANNING, PA 16201
Medicare Provider Number
390163
Participating Start Date
10/1/2021
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
KLINGENSMITH'S DRUG STORE
Pharmacy Address
200 MARKET ST
KITTANNING, PA 16201-1525
Pharmacy Comments
Contract Details
Approval Date
7/28/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew F Kociola, Chief Financial Officer
(724) 543-8618
Contract Pharmacy Representative
Klingensmith's Drug Store
Alicia Wolfe, CFO
(724) 763-4024
Signed By Date
7/12/2021
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