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CLEARFIELD 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
CLEARFIELD PHARMACY
Pharmacy Address
307 E MARKET ST
CLEARFIELD, PA 16830-2432
Pharmacy Comments
Contract Details
Approval Date
7/3/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/26/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Brian Kline, CFO
(814) 375-6377
Contract Pharmacy Representative
Beverly Schickling, Corporate Secretary
(814) 765-7841
Signed By Date
7/3/2013
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