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CHARTWELL PENNSYLVANIA
CAH391316-00 WELLSBORO
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Covered Entity Details
Entity Name
WELLSBORO
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391316-00
Entity Address
32-36 CENTRAL AVENUE
WELLSBORO, PA 16901
Medicare Provider Number
391316
Participating Start Date
4/1/2017
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CHARTWELL PENNSYLVANIA
Pharmacy Address
1001 OAKDALE RD
OAKDALE, PA 15071-1502
Pharmacy Comments
Contract Details
Approval Date
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175
Contract Pharmacy Representative
Chartwell
Kathleen Patrick, PRESIDENT, SPECIALTY PHARMACY AND INFUSION Solutions
(412) 733-1910
Signed By Date
4/9/2025
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