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TITUSVILLE EXPRESS PHARMACY, INC.
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
TITUSVILLE EXPRESS PHARMACY, INC.
Pharmacy Address
401 W SPRING ST
TITUSVILLE, PA 16354
Pharmacy Comments
Contract Details
Approval Date
10/11/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jill A Neely, CFO
(814) 827-8923
Contract Pharmacy Representative
MMCHS
Holli Wolfe, Associate Vice President of Operations
(814) 827-8717
Signed By Date
10/11/2022
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