Covered Entity Details

DSH390090 West Penn Hospital (Active) - information as of 6/8/2025 12:58:07 AM

Main Details

Name

West Penn Hospital

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390090

Medicare Provider Number

390090

Additional Details

Current Program Status

Active

Registration Date

10/19/2005

Participating Start Date

10/20/2005

Participating Approval Date

10/20/2005

Last Recertification Date

8/22/2024

Contacts

Authorizing Official

West Penn Hospital
Brian Johnson, President & CEO
(412) 578-1176

Primary Contact

West Penn Hospital
Robert W Simpson, Director, Pharmacy
(412) 266-8693

Addresses

Street Address

4800 FRIENDSHIP AVE
PITTSBURGH, PA 15224-1722

Billing Address
Same as Street Address

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	1007277200050,1007277200131,1007277200061	1811374606,1346489143,1194744805,1952420325,1427451764,1114324910,1598088056
WV	0001479000
OH	9360516

Shipping Addresses

Shipping Address 1

West Penn Hospital D/B/A AHN Pharmacy #2
4800 Friendship Ave
Suite 1422
Pittsburgh, PA 15224

Shipping Address 2

West Penn Hospital Pharmacy
4800 Friendship Avenue
Pittsburgh, PA 15224

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/18/2017	10/01/2017	05/31/2022	05/31/2022
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/18/2017	10/01/2017	05/31/2022	05/31/2022
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/18/2017	10/01/2017	05/31/2022	05/31/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/18/2017	10/01/2017	05/31/2022	05/31/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/18/2017	10/01/2017	05/31/2022	05/31/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/18/2017	10/01/2017	05/31/2022	05/31/2022
Contract Detail	AGH APOTHECARY	ALLEGHENY GENERAL HOSPITAL	320 E NORTH AVE STE 111	PITTSBURGH	PA	15212-4756	04/09/2012	04/09/2012		02/18/2019
Contract Detail	AHN PHARMACY	12311 PERRY HWY	SUITE F	WEXFORD	PA	15090-8344	10/24/2014	01/01/2015		09/06/2016
Contract Detail	AHN PHARMACY #5	120 5TH AVE STE 300		PITTSBURGH	PA	15222-3025	07/17/2015	10/01/2015	10/01/2022	11/14/2022
Contract Detail	ALLEGHENY HEALTH NETWORK HOME INFUSION	SUITE 500	311 23RD STREET EXT	SHARPSBURG	PA	15215	07/18/2017	10/01/2017		10/01/2017
Contract Detail	ALLEGHENY HEALTH NETWORK HOME INFUSION	1305 S MAIN ST		MEADVILLE	PA	16335-3036	07/18/2017	10/01/2017		10/01/2017
Contract Detail	ASTI'S SOUTH HILLS PHARMACY	250 MOUNT LEBANON BLVD		PITTSBURGH	PA	15234-1252	07/18/2017	10/01/2017	09/30/2020	11/17/2020
Contract Detail	AVELLA OF COLUMBUS	4830 KNIGHTSBRIDGE BLVD STE C		COLUMBUS	OH	43214-2300	07/17/2017	10/01/2017	07/01/2020	10/01/2017
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	07/17/2017	10/01/2017	01/01/2021	02/22/2021
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	07/17/2017	10/01/2017	09/30/2020	09/30/2020
Contract Detail	AVELLA OF SACRAMENTO, INC.	2288 AUBURN BLVD #102		SACRAMENTO	CA	95821	07/17/2017	10/01/2017	09/30/2020	09/30/2020
Contract Detail	BLOOMFIELD DRUG STORE	BLOOMFIELD DRUG STORE	4727 LIBERTY AVE	PITTSBURGH	PA	15224-1522	02/14/2011	02/15/2011	04/15/2024	06/05/2024
Contract Detail	BURRELL PHARMACY	BURRELL HEALTH MART PHARMACY	2889 LEECHBURG RD	LOWER BURRELL	PA	15068-2542	09/20/2012	09/20/2012	01/31/2024	02/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/18/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/18/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	10/16/2017	01/01/2018		10/16/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/18/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/11/2019	04/01/2019		04/01/2019
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	10/16/2017	01/01/2018		10/16/2017
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/18/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/18/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/18/2017	10/01/2017		10/01/2017
Contract Detail	CYSTIC FIBROSIS SERVICES	CYSTIC FIBROSIS SERVICES, INC	10530 JOHN W ELLIOTT DR, STE 200	FRISCO	TX	75033	01/18/2016	04/01/2016	03/21/2018	03/21/2018
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/06/2017	07/01/2017		07/06/2017
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/18/2017	10/01/2017	07/01/2022	11/14/2022
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/18/2017	10/01/2017	07/01/2022	11/14/2022
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/18/2017	10/01/2017	07/01/2022	11/14/2022
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/18/2017	10/01/2017	07/01/2022	11/14/2022
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	255 PHILLIPI ROAD	COLUMBUS	OH	43228	07/18/2017	10/01/2017	07/01/2022	11/14/2022
Contract Detail	FORBES HOSPITAL	2570 HAYMAKER ROAD	PHARMACY	MONROEVILLE	PA	15146	01/11/2019	04/01/2019		04/01/2019
Contract Detail	GIANT EAGLE PHARMACY #0002	1800 MCKEES ROCKS RD		MCKEES ROCKS	PA	15136	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #0008	200 TARENTUM BRIDGE RD		NEW KENSINGTON	PA	15068	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0010	8901 STATE ROUTE 30		NORTH HUNTINGDON	PA	15642	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #0014	7000 OXFORD DRIVE		BETHEL PARK	PA	15102	02/14/2011	02/15/2011	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #0015	ROUTE #30	1701 LINCOLN HIGHWAY	NORTH VERSAILLES	PA	15137	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #0017	6401 PENN AVE		PITTSBURGH	PA	15206	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0018	1671 BUTLER PLANK		GLENSHAW	PA	15116	04/24/2012	04/24/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0025	WEST VIEW PLAZA	1029 WEST VIEW PARK DRIVE	PITTSBURGH	PA	15229	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #0032	4810 OLD WILLIAM PENN HIGHWAY		EXPORT	PA	15632	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #0037	5 QUAKER VILLAGE SHOPPING CENTER		LEETSDALE	PA	15056	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #0040	5550 CENTRE AVE		PITTSBURGH	PA	15232	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0041	41 TOWNE CENTER DR		LEECHBURG	PA	15656	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0052	132 BEN AVON HTS ROAD		PITTSBURGH	PA	15237	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0060	4010 MONROEVILLE BLVD.		MONROEVILLE	PA	15146	02/14/2011	02/15/2011	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0065	4110 BRIGHTON ROAD		PITTSBURGH	PA	15212	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #0066	2650 CONSTITUTION BOULEVARD		BEAVER FALLS	PA	15010	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #0067	8080 MCINTYRE SQUARE DRIVE		PITTSBURGH	PA	15237	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0069	9001 FRANKSTOWN RD		PITTSBURGH	PA	15235	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0072	910 FREEPORT ROAD		PITTSBURGH	PA	15238	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0075	1600 STATE ST	NORTHERN LIGHT SHOPPING PLAZA	BADEN	PA	15005	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #0077	254 YOST BOULEVARD		PITTSBURGH	PA	15221	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #0078	230 RODI ROAD		PITTSBURGH	PA	15235	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #0091	318 CEDAR AVENUE		PITTSBURGH	PA	15212	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #0093	600 TOWNE SQUARE WAY		BRENTWOOD	PA	15227	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #0094	3113 GREEN GARDEN ROAD		ALIQUIPPA	PA	15001	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #1220	2001 LINCOLN WAY		WHITE OAK	PA	15131	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #1236	2000 PENNY LANE DRIVE		JEANNETTE	PA	15644	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #1288	200 STATION ST		MCDONALD	PA	15057	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #1291	400 NORTHTOWNE SQUARE		GIBSONIA	PA	15044	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #1619	EDGEWOOD TOWNE CENTER	1705 SOUTH BRADDOCK AVE	PITTSBURGH	PA	15218	04/26/2012	04/26/2012	04/15/2024	06/05/2024
Contract Detail	GIANT EAGLE PHARMACY #2404	200 ALLEGHENY RIVER BLVD		VERONA	PA	15147	04/26/2012	04/26/2012	07/30/2018	01/11/2019
Contract Detail	GIANT EAGLE PHARMACY #5103	2611 FREEPORT RD		PITTSBURGH	PA	15238	04/26/2012	04/26/2012	07/17/2017	07/18/2017
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	07/15/2021	10/01/2021	04/15/2024	06/05/2024
Contract Detail	HEIGHTS HEALTHMART PHARMACY	1633 UNION AVE		NATRONA HEIGHTS	PA	15065-2103	09/20/2012	09/20/2012	07/01/2020	02/22/2021
Contract Detail	JEFFERSON REGIONAL MEDICAL CENTER	565 COAL VALLEY ROAD		JEFFERSON HILLS	PA	15025	01/11/2019	04/01/2019		04/01/2019
Contract Detail	JEFFREYS DRUG STORE	1 NORTH CENTRAL AVE		CANONSBURG	PA	15317-1531	02/09/2011	02/09/2011	09/30/2020	11/17/2020
Contract Detail	LEECHBURG HEALTHMART PHARMACY	165 MARKET ST		LEECHBURG	PA	15656-1334	09/20/2012	09/20/2012	01/31/2024	02/01/2024
Contract Detail	LEECHBURG PHRMY-LONG TERM CARE	111 2ND ST		LEECHBURG	PA	15656-1326	09/20/2012	09/20/2012	07/17/2017	07/18/2017
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	01/18/2016	04/01/2016		03/30/2024
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/15/2020	07/15/2020	10/01/2023	10/19/2023
Contract Detail	OPTUM PHARMACY 806, INC.	2288 AUBURN BLVD	STE. 102	SACRAMENTO	CA	95821-1618	07/15/2020	07/15/2020	10/01/2023	10/19/2023
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/25/2017	10/01/2017	01/02/2023	02/14/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/18/2017	10/01/2017		10/01/2017
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	01/18/2016	04/01/2016		03/30/2024
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	01/18/2016	04/01/2016		03/30/2024
Contract Detail	TOWNE DRUGS LLC	227 COMMERCIAL AVE		ASPINWALL	PA	15215	08/31/2012	08/31/2012	09/30/2020	11/17/2020
Contract Detail	VALEDA RX	250 MT. LEBANON BLVD.	SUITE 208	PITTSBURGH	PA	15234	07/18/2017	10/01/2017	09/30/2020	11/17/2020
Contract Detail	VANDERGRIFT PHARMACY INC	VANDERGRIFT HEALTHMART PHARMACY	224 LONGFELLOW ST	VANDERGRIFT	PA	15690-1476	12/10/2012	01/01/2013	04/15/2024	06/05/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/18/2016	04/01/2016	12/31/2021	02/07/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/18/2016	04/01/2016		09/06/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/18/2016	04/01/2016		09/06/2016
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/18/2016	04/01/2016		09/06/2016
Contract Detail	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	01/13/2011	01/13/2011		09/06/2016
Contract Detail	WILSON'S PHARMACY	4101 PENN AVE STE A		PITTSBURGH	PA	15224-1326	08/16/2012	08/16/2012	09/30/2020	11/17/2020

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH390090A	Child	DSH	West Penn Hospital	OUTPATIENT SERVICE AT ALLEGHENY VALLEY HOSPITAL	1301 CARLISLE ST	NATRONA HEIGHTS	PA	Active
DSH390090B	Child	DSH	West Penn Hospital	OUTPATIENT SERVICES AT PETERS TOWNSHIP	160 GALLERY DR	MC MURRAY	PA	Active
DSH390090C	Child	DSH	West Penn Hospital	OUTPATIENT SERVICES AT ALLEGHENY GENERAL HOSPITAL	314 East North Avenue	PITTSBURGH	PA	Active
DSH390090E	Child	DSH	West Penn Hospital	WEST PENN HOSPITAL OUTPATIENT SERVICES AT FORBES	2626 HAYMAKER RD	MONROEVILLE	PA	Active
DSH390090F	Child	DSH	West Penn Hospital	WEST PENN HOSPITAL OUTPATIENT SERVICES AT MELLON PAVILION	4815 LIBERTY AVENUE	PITTSBURGH	PA	Active
DSH390090G	Child	DSH	West Penn Hospital	WEST PENN HOSPITAL OUTPATIENT SERVICES AT BUTLER	160 Hollywood Dr	BUTLER	PA	Active
DSH390090J	Child	DSH	West Penn Hospital	West Penn Hospital Outpatient Services at Hansen	300 HANSEN PLAZA	LYNDORA	PA	Terminated
DSH390090L	Child	DSH	West Penn Hospital	WEST PENN HOSPITAL OUTPATIENT SERVICES AT NEW KENSINGTON	651 FOURTH AVENUE	NEW KENSINGTON	PA	Terminated
DSH390090M	Child	DSH	WEST PENN HOSPITAL	AHN Center for Diabetes	5140 Liberty Avenue	Pittsburgh	PA	Terminated
DSH390090N	Child	DSH	West Penn Hospital	WEST PENN HOSPITAL OUTPATIENT SERVICES AT JEFFERSON	575 Coal Valley Rd	Jefferson Hills	PA	Active
DSH390090P	Child	DSH	West Penn Hospital	West Penn Hospital Outpatient Services at Wexford	12311 Perry Highway Suite A	Wexford	PA	Active
DSH390090Q	Child	DSH	West Penn Hospital	West Penn Hospital Outpatient Services at Bethel Park	990 Higbee Drive	Bethel Park	PA	Active
DSH390090R	Child	DSH	West Penn Hospital	Institute for Pain Medicine	5124 Liberty Ave	Pittsburgh	PA	Active
DSH390090S	Child	DSH	West Penn Hospital	AHN CANCER INSTITUTE BEAVER - Oncology	81 WAGNER ROAD	MONACA	PA	Active
DSH390090T	Child	DSH	West Penn Hospital	AHN CANCER INSTITUTE ROBINSON - Oncology	THREE ROBINSON PLAZA SUITE 430	PITTSBURGH	PA	Active
DSH390090U	Child	DSH	West Penn Hospital	AHN Cancer Institute Hempfield - Oncology	6321 Route 30, Suite 300	Greensburg	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Simpson, Robert W Director, Pharmacy West Penn Hospital 4125787477	Simpson, Robert W Director, Pharmacy West Penn Hospital 4122668693	3/19/2025 1:57 PM
Addresses	Shipping Address	Insert	Change Request		West Penn Hospital Pharmacy 4800 Friendship Avenue Pittsburgh, PA 15224	3/5/2025 8:00 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1765805 (LA)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1194744805 (NC)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	9000210527 (CO)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	250969492001 (IL)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	105505 (AZ)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007277200108 (PA)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	008565100 (MD)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	XHSP42710 (CA)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	003162916A (GA)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1194744805 (MN)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	08102885 (MS)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	4191901 (NJ)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	10689B (SC)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	0390090 (TN)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1194744805 (VA)		8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1194744805 (WI)		8/22/2024 3:57 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1427451764	8/22/2024 3:57 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/22/2024 3:57 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1114324910	8/22/2024 3:57 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/22/2024 3:57 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1598088056	8/22/2024 3:57 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	8/22/2024 3:57 PM
Details	Last Recertification Date	Update	Recertification	8/31/2023 1:12:30 PM	8/22/2024 3:57:16 PM	8/22/2024 3:57 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		9000210527	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		250969492001	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		105505	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007277200108	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	093260400 (FL)		8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	01570688 (KY)		8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Delete	Recertification	00739886 (NY)		8/31/2023 1:12 PM
Details	Last Recertification Date	Update	Recertification	9/22/2022 12:09:52 PM	8/31/2023 1:12:30 PM	8/31/2023 1:12 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	954760 (AZ)		7/31/2023 8:54 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	008067112 (CT)		7/31/2023 8:54 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	250969492001 (IL)		7/31/2023 8:54 AM
Details	Last Recertification Date	Update	Recertification	8/19/2021 10:57:26 AM	9/22/2022 12:09:52 PM	9/22/2022 12:09 PM
Details	Last Recertification Date	Update	Recertification	9/3/2020 10:52:02 AM	8/19/2021 10:57:26 AM	8/19/2021 10:57 AM
Contacts	Authorizing Official	Update	Profile Change Request	Johnson, Brian President & CEO (Interim) West Penn Hospital 4125781176	Johnson, Brian President & CEO West Penn Hospital 4125781176	2/22/2021 9:49 AM
Contacts	Authorizing Official	Update	Change Request	Andro, Ronald J President & CEO West Penn Hospital 4125781176	Johnson, Brian President & CEO (Interim) West Penn Hospital 4125781176	9/21/2020 1:25 PM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/3/2020 10:52 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/3/2020 10:52 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/3/2020 10:52 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/3/2020 10:52 AM
Details	Last Recertification Date	Update	Recertification	9/9/2019 8:33:38 AM	9/3/2020 10:52:02 AM	9/3/2020 10:52 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007317140457 (PA)		7/15/2020 12:50 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007277200130 (PA)		7/15/2020 12:50 PM
Addresses	Main Address	Update	Change Request	4800 FRIENDSHIP AVENUE PITTSBURGH, PA 15224	4800 FRIENDSHIP AVE PITTSBURGH, PA 15224-1722	10/23/2019 11:05 AM
Details	Last Recertification Date	Update	Recertification	9/11/2018 7:40:43 AM	9/9/2019 8:33:38 AM	9/9/2019 8:33 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1765805	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		LA	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1194744805	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		NC	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	1479000	0001479000	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	8565100	008565100	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	XHSP32710	XHSP42710	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	10777A	10689B	4/16/2019 10:57 AM
Medicaid Billing	Medicaid: Number	Update	Change Request	0930090	0390090	4/16/2019 10:57 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 8:39:09 PM	9/11/2018 7:40:43 AM	9/11/2018 7:40 AM
Contacts	Primary Contact	Update	Change Request	Davis, Jennifer Director West Penn Hospital 4125784050	Simpson, Robert W Director, Pharmacy West Penn Hospital 4125787477	4/30/2018 2:23 PM
Contacts	Primary Contact	Update	Change Request	Davis, Jennifer Director West Penn Hospital 4125784050	Davis, Jennifer Director West Penn Hospital 4125784050	4/2/2018 7:41 AM
Contacts	Authorizing Official	Update	Change Request	Andro, Ron President and CEO West Penn Hospital 4125781176	Andro, Ronald J President & CEO West Penn Hospital 4125781176	4/2/2018 7:41 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		954760	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		XHSP32710	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CA	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		008067112	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		CT	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		093260400	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		FL	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		003162916A	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		GA	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		250969492001	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		01570688	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		KY	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1194744805	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MN	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		08102885	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		MS	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		4191901	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NJ	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		00739886	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		NY	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		10777A	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		SC	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0930090	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		TN	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1194744805	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VA	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1194744805	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		WI	3/9/2018 3:43 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	1573000	1479000	1/24/2018 4:33 PM
Medicaid Billing	Medicaid: Number	Update	Change Request	295215700	8565100	1/24/2018 4:33 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/24/2018 4:33 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		9360516	1/24/2018 4:33 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		OH	1/24/2018 4:33 PM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	11/29/2017 8:39:09 PM	11/29/2017 8:39 PM
Contacts	Authorizing Official	Update		Andro, Ron President and CEO 4125781176	Andro, Ron President and CEO West Penn Hospital 4125781176	10/16/2017 2:46 PM
Contacts	Primary Contact	Update		Davis, Jennifer Director 4125784050	Davis, Jennifer Director West Penn Hospital 4125784050	10/16/2017 2:09 PM
Contacts	Authorizing Official	Update		Burfitt, Gregory CEO 4125787137	Andro, Ron President and CEO 4125781176	7/25/2017 1:30 PM
Contacts	Primary Contact	Update		YARNELL, ERIC DIRECTOR OF PHARMACY 4125783561	Davis, Jennifer Director 4125784050	9/6/2016 1:58 PM
Addresses	Main Address	Insert			4800 FRIENDSHIP AVENUE PITTSBURGH, PA 15224	9/6/2016 1:58 PM
Addresses	Shipping Address	Insert			West Penn Hospital D/B/A AHN Pharmacy #2 4800 Friendship Ave Suite 1422 Pittsburgh, PA 15224	9/6/2016 1:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Number	Insert			1007277200130	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: State	Insert			PA	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Number	Insert			1007277200131	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: State	Insert			PA	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Number	Insert			1573000	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: State	Insert			WV	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Number	Insert			295215700	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: State	Insert			MD	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	9/6/2016 1:52 PM
Details	Last Recertification Date	Update		9/8/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 1:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/11/2016 5:52 PM
Medicaid Billing	Medicaid: Number	Insert			1007277200050	2/11/2016 5:52 PM
Medicaid Billing	Medicaid: State	Insert			PA	2/11/2016 5:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/11/2016 5:52 PM
Medicaid Billing	Medicaid: Number	Insert			1007317140457	2/11/2016 5:52 PM
Medicaid Billing	Medicaid: State	Insert			PA	2/11/2016 5:52 PM
Medicaid Billing	NPI: Number	Insert			1952420325	2/11/2016 5:52 PM
Medicaid Billing	NPI: Number	Insert			1194744805	2/9/2016 2:37 PM
Medicaid Billing	NPI: Number	Insert			1811374606	12/30/2015 3:46 PM
Medicaid Billing	NPI: Number	Insert			1346489143	12/30/2015 3:46 PM
Details	Last Recertification Date	Update		9/4/2014 12:00:00 AM	9/8/2015 12:00:00 AM	9/8/2015 5:37 PM
Details	Last Recertification Date	Update		9/13/2013 12:00:00 AM	9/4/2014 12:00:00 AM	9/4/2014 1:17 PM
Details	Entity Name	Update		THE WESTERN PENNSYLVANIA HOSPITAL	West Penn Hospital	10/22/2013 1:04 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/13/2013 12:00:00 AM	9/13/2013 6:21 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/18/2012 12:32 PM
Contacts	Primary Contact	Insert			YARNELL, ERIC DIRECTOR OF PHARMACY 4125783561	9/29/2011 1:17 PM
Contacts	Authorizing Official	Insert			Burfitt, Gregory CEO 4125787137	9/22/2011 9:17 AM
Details	Last Recertification Date	Insert				1/27/2011 3:58 PM
Details	Grant Number	Insert				1/27/2011 3:58 PM
Details	340B ID	Insert			DSH390090	1/27/2011 3:58 PM
Details	Is Authorizing Official EHB Data	Insert				1/27/2011 3:58 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/27/2011 3:58 PM
Details	Medicare Provider Number	Insert			390090	1/27/2011 3:58 PM
Details	Entity Name	Insert			THE WESTERN PENNSYLVANIA HOSPITAL	1/27/2011 3:58 PM
Details	Program Code	Insert			DSH	1/27/2011 3:58 PM
Details	Entity Subname	Insert				1/27/2011 3:58 PM
Dates	Participating Approval Date	Insert			10/20/2005 12:00:00 AM	1/27/2011 3:58 PM
Details	State	Insert			Active	1/27/2011 3:58 PM
Dates	Registration Date	Insert			10/19/2005 12:00:00 AM	1/27/2011 3:58 PM
Dates	Signed By Date	Insert			10/14/2005 12:00:00 AM	1/27/2011 3:58 PM
Dates	Start Date	Insert			10/20/2005 12:00:00 AM	1/27/2011 3:58 PM
Terminations	Termination Comments	Insert				1/27/2011 3:58 PM
Terminations	Termination Date	Insert				1/27/2011 3:58 PM
Terminations	Termination Effective Date	Insert				1/27/2011 3:58 PM
Terminations	Termination Reason	Insert				1/27/2011 3:58 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	10/19/2005 10:14 AM
Medicaid Billing	Medicaid: Number	Insert			1007277200061	10/19/2005 10:14 AM
Medicaid Billing	Medicaid: State	Insert			PA	10/19/2005 10:14 AM