Contract Pharmacy Details

ALTRUIX
CAH391314-00 TITUSVILLE AREA HOSPITAL

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

ALTRUIX

Pharmacy Address

3800 HORIZON BLVD STE 103
TREVOSE, PA 19053

Pharmacy Comments

Contract Details

Approval Date

1/16/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jill A Neely, CFO
(814) 827-8923

Contract Pharmacy Representative

Altruix
Michael Metry, PIC
(800) 927-6703

Signed By Date

1/16/2024