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St. Mary's Pharmacy
DSH390086 DUBOIS REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
DUBOIS REGIONAL MEDICAL CENTER
Subdivision Name
dba Penn Highlands DuBois
Type
Disproportionate Share Hospital
340B ID
DSH390086
Entity Address
100 HOSPITAL AVENUE
DUBOIS, PA 15801
Medicare Provider Number
390086
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
St. Mary's Pharmacy
Pharmacy Address
4 Railroad Street
St. Marys, PA 15857
Pharmacy Comments
Contract Details
Approval Date
12/15/2011
Contract Begin Date
12/15/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/1/2022
Ownership change
Contacts
Covered Entity Signing Official
Patricia Cressley, CFO
(814) 375-6299
Contract Pharmacy Representative
Frank Straub, Owner
(814) 834-3017
Signed By Date
12/6/2011
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