Contract Pharmacy Details

MCCABE DRUG, LLC
DSH390086 DUBOIS REGIONAL MEDICAL CENTER

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

MCCABE DRUG, LLC

Pharmacy Address

419 MAIN STREET
REYNOLDSVILLE, PA 15851

Pharmacy Comments

Contract Details

Approval Date

1/11/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/28/2017
Ownership change

Contacts

Covered Entity Signing Official

Brian Kline, CFO
(814) 375-6377

Contract Pharmacy Representative

Jim Killian, Owner
(814) 653-8295

Signed By Date

1/11/2017