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GIANT EAGLE PHARMACY #0080
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
GIANT EAGLE PHARMACY #0080
Pharmacy Address
40 WHITE STREET
BROOKVILLE, PA 15825
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian Kline, CFO
(814) 375-6377
Contract Pharmacy Representative
Debra Krasnow, Director of Managed Care
(412) 968-1550
Signed By Date
10/16/2014
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