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SPROUT'S DRUG STORE
CAH391313-00 CHARLES COLE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHARLES COLE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391313-00
Entity Address
1001 EAST 2ND STREET
COUDERSPORT, PA 16915
Medicare Provider Number
391313
Participating Start Date
8/25/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
SPROUT'S DRUG STORE
Pharmacy Address
122 EAST ACADEMY STREET
SHINGLEHOUSE, PA 16748
Pharmacy Comments
Contract Details
Approval Date
4/18/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Rapp, VP Finance
(814) 274-5250
Contract Pharmacy Representative
Darling Apothecary LLC
Chris Darling, Owner
(814) 688-0113
Signed By Date
4/18/2018
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