Covered Entity Details

DSH390028R UPMC MERCY (Active) - information as of 6/12/2025 6:00:36 AM

Main Details

Name

UPMC MERCY

Subdivision Name

MERCY-SURG PAVILION - (21255)

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390028R

Medicare Provider Number

390028

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/12/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/18/2024

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

UPMC
Jonathan Petrie, CFO UPMC Magee and Mercy
(412) 578-9416

Primary Contact

UPMC Mercy
Sandra Elizabeth Nickman, Pharmacy, Director
(724) 396-8449

Addresses

Street Address

1622 Locust Street
Pittsburgh, PA 15219

Billing Address

UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain
PO Box 2058
Portland, OR 97208

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
PA	1001380890012,1001380890043,1001380890017,100138080044,1001380890013,1001380890045	1881695146,1639143084,1568526135,1225004047

Shipping Addresses

Shipping Address 1

UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain
3175 E Carson St
Pittsburgh, PA 15203

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH390028B	Child	DSH	UPMC MERCY	UPMC Mercy Southside Outpatient Center - GI Lab	2000 Mary Street	Pittsburgh	PA	Terminated
DSH390028C	Child	DSH	UPMC MERCY	UPMC Mercy Southside Outpatient Center - Infusion Therapy	2000 Mary Street	Pittsburgh	PA	Terminated
DSH390028D	Child	DSH	UPMC MERCY	UPMC Mercy Southside Outpatient Center - Pain Mgmt	2000 Mary Street	Pittsburgh	PA	Terminated
DSH390028E	Child	DSH	UPMC MERCY	UPMC Mercy Southside Outpatient Center - OR	2000 Mary Street	Pittsburgh	PA	Terminated
DSH390028G	Child	DSH	UPMC MERCY	UPMC Mercy - SMARTH Health Greentree	969 Greentree Road	Pittsburgh	PA	Terminated
DSH390028H	Child	DSH	UPMC MERCY	UPMC Mercy - SH Greentree Cardio	969 Greentree Road	Pittsburgh	PA	Terminated
DSH390028K	Child	DSH	UPMC MERCY	UPMC Mercy Health Center Diabetes Clinic (36279)	1515 Locust Street	Pittsburgh	PA	Terminated
DSH390028L	Child	DSH	UPMC MERCY	UPMC Mercy Health Center - UPMC Mercy Health Center Surgical Center	1515 Locust Street	Pittsburgh	PA	Active
DSH390028M	Child	DSH	UPMC MERCY	UPMC Mercy Health Center - Internal Medicine Clinic (34387)	1515 Locust Street	Pittsburgh	PA	Active
DSH390028N	Child	DSH	UPMC MERCY	UPMC Mercy Health Center GI Clinic - Gastroenterology	1515 Locust Street	Pittsburgh	PA	Terminated
DSH390028P	Child	DSH	UPMC MERCY	MERCY - SS Collection Center - Infusion (30683)	2000 Mary Street	Pittsburgh	PA	Terminated
DSH390028Q	Child	DSH	UPMC MERCY	Wound Center - (36846)	1515 Locust Street	Pittsburgh	PA	Active
DSH390028R	Child	DSH	UPMC MERCY	MERCY-SURG PAVILION - (21255)	1622 Locust Street	Pittsburgh	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Group Change Request	PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. PITTSBURGH, PA 15203	UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain PO Box 2058 Portland, OR 97208	5/6/2025 2:23 PM
Addresses	Shipping Address	Delete	Group Change Request	PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. Pittsburgh, PA 15203		5/6/2025 2:23 PM
Addresses	Shipping Address	Insert	Group Change Request		UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain 3175 E Carson St Pittsburgh, PA 15203	5/6/2025 2:23 PM
Contacts	Primary Contact	Update	PC Change Request	Sargent, Andrea DIRECTOR, PHARMACY SERVICES UPMC Mercy 4122323696	Nickman, Sandra Elizabeth Pharmacy, Director UPMC Mercy 7243968449	3/20/2025 1:02 PM
Addresses	Main Address	Update	Change Request	1622 Locust Street Pittsburgh, PA, PA 15219	1622 Locust Street Pittsburgh, PA 15219	12/12/2024 1:50 PM
Addresses	Shipping Address	Delete	Recertification	PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. Pittsbrugh, PA 15203		9/3/2024 2:41 PM
Addresses	Shipping Address	Insert	Recertification		PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. Pittsburgh, PA 15203	9/3/2024 2:41 PM
Details	Last Recertification Date	Update	Recertification		9/3/2024 2:41:25 PM	9/3/2024 2:41 PM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Petrie, Jonathan CFO UPMC Magee and Mercy UPMC 4125789416	1/18/2024 11:03 AM
Details	340B ID	Update	New Registration		DSH390028R	1/18/2024 11:03 AM
Details	Entity Name	Update	New Registration	UPMC MERCY HOSPITAL	UPMC MERCY	1/18/2024 11:03 AM
Details	Entity Subname	Update	New Registration	MERCY-SURG PAVILION	MERCY-SURG PAVILION - (21255)	1/18/2024 11:03 AM
Dates	Participating Approval Date	Update	New Registration		1/18/2024 11:03:45 AM	1/18/2024 11:03 AM
Details	State	Update	New Registration	Pending	Approved	1/18/2024 11:03 AM
Dates	Signed By Date	Update	New Registration		1/12/2024 11:33:01 AM	1/18/2024 11:03 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/18/2024 11:03 AM
Addresses	Main Address	Insert	New Registration		1622 Locust Street Pittsburgh, PA, PA 15219	1/12/2024 11:32 AM
Addresses	Billing Address	Insert	New Registration		PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. PITTSBURGH, PA 15203	1/12/2024 11:32 AM
Addresses	Shipping Address	Insert	New Registration		PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. Pittsbrugh, PA 15203	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1001380890012	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1001380890043	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1001380890017	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		100138080044	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1001380890013	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1001380890045	1/12/2024 11:32 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1881695146	1/12/2024 11:32 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1225004047	1/12/2024 11:32 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1639143084	1/12/2024 11:32 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1568526135	1/12/2024 11:32 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	1/12/2024 11:32 AM
Contacts	Primary Contact	Insert	New Registration		Sargent, Andrea DIRECTOR, PHARMACY SERVICES UPMC Mercy 4122323696	1/12/2024 11:32 AM
Contacts	Authorizing Official	Insert	New Registration		Petrie, Jonathan CFO UPMC Magee and Mercy UPMC 4125789416	1/12/2024 11:32 AM
Details	Assistance Received From Date	Insert	New Registration			1/12/2024 11:32 AM
Details	Assistance Received To Date	Insert	New Registration			1/12/2024 11:32 AM
Details	Last Recertification Date	Insert	New Registration			1/12/2024 11:32 AM
Details	Grant Number	Insert	New Registration			1/12/2024 11:32 AM
Details	340B ID	Insert	New Registration			1/12/2024 11:32 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/12/2024 11:32 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/12/2024 11:32 AM
Details	Medicare Provider Number	Insert	New Registration		390028	1/12/2024 11:32 AM
Details	Entity Name	Insert	New Registration		UPMC MERCY HOSPITAL	1/12/2024 11:32 AM
Details	NOFO Number	Insert	New Registration			1/12/2024 11:32 AM
Details	Program Code	Insert	New Registration		DSH	1/12/2024 11:32 AM
Details	Entity Subname	Insert	New Registration		MERCY-SURG PAVILION	1/12/2024 11:32 AM
Dates	Participating Approval Date	Insert	New Registration			1/12/2024 11:32 AM
Details	State	Insert	New Registration		Pending	1/12/2024 11:32 AM
Dates	Registration Date	Insert	New Registration		1/12/2024 11:32:55 AM	1/12/2024 11:32 AM
Dates	Signed By Date	Insert	New Registration			1/12/2024 11:32 AM
Dates	Start Date	Insert	New Registration			1/12/2024 11:32 AM
Terminations	Termination Comments	Insert	New Registration			1/12/2024 11:32 AM
Terminations	Termination Date	Insert	New Registration			1/12/2024 11:32 AM
Terminations	Termination Effective Date	Insert	New Registration			1/12/2024 11:32 AM
Terminations	Termination Reason	Insert	New Registration			1/12/2024 11:32 AM