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THE MEDICINE SHOPPE
CAH391312-00 BROOKVILLE HOSPITAL
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Covered Entity Details
Entity Name
BROOKVILLE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391312-00
Entity Address
100 HOSPITAL ROAD
BROOKVILLE, PA 15825
Medicare Provider Number
391312
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
THE MEDICINE SHOPPE
Pharmacy Address
301 W MAIN ST
SUITE 3
BROOKVILLE, PA 15825
Pharmacy Comments
Contract Details
Approval Date
10/20/2011
Contract Begin Date
10/5/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
JULIANNE PEER, President
(814) 849-1461
Contract Pharmacy Representative
The Medicine Shoppe
Daniel Brown, Owner
(814) 641-7442
Signed By Date
9/29/2011
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