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UPMC WELLSBORO PHARMACY
CH03122J N PENN COMPREHENSIVE HEALTH SVCS
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Covered Entity Details
Entity Name
N PENN COMPREHENSIVE HEALTH SVCS
Subdivision Name
BLOSSBURG LAUREL HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH03122J
Entity Address
6 Riverside Plaza
Blossburg, PA 16912-1137
Grant Number
H80CS00682
Participating Start Date
1/1/2009
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
UPMC WELLSBORO PHARMACY
Pharmacy Address
32-36 CENTRAL AVE
WELLSBORO, PA 16901
Pharmacy Comments
Contract Details
Approval Date
5/1/2009
Contract Begin Date
5/1/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Williamsport Hospital and Medical Center
JAN FISHER, PRESIDENT & CEO
(570) 723-0100
Signed By Date
4/13/2009
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