Covered Entity Details

DSH390028 UPMC MERCY (Active) - information as of 4/29/2025 12:30:51 AM

Main Details

Name

UPMC MERCY

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390028

Medicare Provider Number

390028

Additional Details

Current Program Status

Active

Registration Date

11/23/2005

Participating Start Date

9/2/2008

Participating Approval Date

9/2/2008

Last Recertification Date

8/29/2024

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

1400 LOCUST STREET
PITTSBURGH, PA 15219

Billing Address

PROCUREMENT: H C PHARMACY CENTRAL
3175 EAST CARSON ST.
PITTSBURGH, PA 15203

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
9/1/09-DOC RECD TO CONFIRM ELIG DSH ADJ %; 9/17/08-ADDED BILL&SHIPPING ADDRESS; ORIG PART FROM 11/25/05 TO 3/31/08, NOT ELIG FROM 4/1/08 THRU 9/1/08, 9/2/08 NAME CHANGE (WAS PITTSBURGH MERCY HEALTH SYSTEM), MED # CHANGE (WAS 1001380890042)	11/18/2009

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	1881695146,1225004047,1639143084,1568526135

Shipping Addresses

Shipping Address 1

UPMC MERCY OUTPATIENT PHARMACY
1622 Locust Street
Pittsburgh, PA 15219

Shipping Address 2

HC PHARMACY CENTRAL
3175 E CARSON ST
PITTSBURGH, PA 15203

Shipping Address 3

UPMC MERCY PHARMACY
1400 LOCUST ST
PITTSBURGH, PA 15219

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	07/12/2022	10/01/2022		10/16/2023
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/12/2022	10/01/2022		10/16/2023
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/12/2022	10/01/2022		10/16/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/12/2022	10/01/2022	05/31/2023	10/16/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/12/2022	10/01/2022		10/16/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/12/2022	10/01/2022		10/16/2023
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/12/2024	04/01/2024		04/01/2024
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/19/2017	10/01/2017		10/01/2017
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CHARTWELL PENNSYLVANIA	1001 OAKDALE RD		OAKDALE	PA	15071-1502	10/17/2016	01/01/2017		10/17/2016
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/12/2024	04/01/2024		04/01/2024
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/12/2024	04/01/2024		04/01/2024
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/13/2021	10/01/2021		10/01/2021
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	ECKERD CORPORATION	RITE AID #10808	4937 TRANSIT ROAD	DEPEW	NY	14043	07/12/2023	10/01/2023		10/01/2023
Contract Detail	ECKERD CORPORATION	RITE AID #10987	100 SEVEN FIELDS BLVD	SEVEN FIELDS	PA	16046	07/12/2023	10/01/2023		10/01/2023
Contract Detail	FALK PHARMACY	3601 5TH AVE STE 211		PITTSBURGH	PA	15213-3403	07/12/2011	07/15/2011		03/28/2013
Contract Detail	FORBES PHARMACY	3501 FORBES AVE	ROOM 756	PITTSBURGH	PA	15213	01/12/2023	04/01/2023		04/01/2023
Contract Detail	GIANT EAGLE PHARMACY #0002	1800 MCKEES ROCKS RD		MCKEES ROCKS	PA	15136	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0004	5055 LIBRARY RD		BETHEL PARK	PA	15102	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0005	3701 ROUTE 88		FINLEYVILLE	PA	15332	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0014	7000 OXFORD DRIVE		BETHEL PARK	PA	15102	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0017	6401 PENN AVE		PITTSBURGH	PA	15206	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #0019	1233 BROAD ST		JOHNSTOWN	PA	15906	07/10/2020	10/01/2020	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #0031	5260 GROVE ROAD	BAPTIST & GROVE ROADS	PITTSBURGH	PA	15236	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #0047	100 SETTLERS RIDGE CENTER DR		PITTSBURGH	PA	15205	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0060	4010 MONROEVILLE BLVD.		MONROEVILLE	PA	15146	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0060	4010 MONROEVILLE BLVD.		MONROEVILLE	PA	15146	07/13/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0061	2021 WHARTON ST		PITTSBURGH	PA	15203	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #0063	4250 MURRAY AVENUE		PITTSBURGH	PA	15217	07/13/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0069	9001 FRANKSTOWN RD		PITTSBURGH	PA	15235	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0070	4007 WASHINGTON ROAD		MCMURRAY	PA	15317	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0073	9901 MOUNTAINVIEW DRIVE		WEST MIFFLIN	PA	15122	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0074	1165 MCKINNEY LANE	PARKWAY CENTER MALL	PITTSBURGH	PA	15220	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #0078	230 RODI ROAD		PITTSBURGH	PA	15235	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #0078	230 RODI ROAD		PITTSBURGH	PA	15235	07/13/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0093	600 TOWNE SQUARE WAY		BRENTWOOD	PA	15227	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #0098	581 PITTSBURGH RD		UNIONTOWN	PA	15401	07/10/2020	10/01/2020	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	07/13/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #1241	1025 WASHINGTON PIKE	ROUTE 50	BRIDGEVILLE	PA	15017	08/15/2012	08/15/2012	09/19/2016	09/28/2016
Contract Detail	GIANT EAGLE PHARMACY #1246	51 WALSH RD		PITTSBURGH	PA	15205	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #1619	EDGEWOOD TOWNE CENTER	1705 SOUTH BRADDOCK AVE	PITTSBURGH	PA	15218	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #2445	419 S MAIN STREET		GREENVILLE	PA	16125	07/10/2020	10/01/2020	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #6379	420 EAST WATERFRONT DRIVE		HOMESTEAD	PA	15120	08/15/2012	08/15/2012	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #6379	420 EAST WATERFRONT DRIVE		HOMESTEAD	PA	15120	07/13/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	07/10/2020	10/01/2020	04/09/2021	04/09/2021
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	07/13/2021	10/01/2021		10/01/2021
Contract Detail	HILLMAN CENTER PHARMACY	5115 CENTRE AVE RM AG30.1		PITTSBURGH	PA	15232	07/12/2011	07/15/2011		03/28/2013
Contract Detail	ONCOMED PHARMACEUTICAL SERVICES OF MA, L	D/B/A ONCO360	335 BEAR HILL RD STE 2100	WALTHAM	MA	02451	04/14/2022	07/01/2022		07/01/2022
Contract Detail	ONCOMED THE ONCOLOGY PHARMACY OF BUFFALO	D/B/A ONCO360	140 JOHN JAMES AUDUBON PKWY STE 101	AMHERST	NY	14228	10/12/2021	01/01/2022	04/07/2022	04/14/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04369	4610 CENTRE AVE	PITTSBURGH	PA	15213	10/10/2023	01/01/2024		01/01/2024
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	07/12/2022	10/01/2022	10/11/2022	10/11/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/19/2017	10/01/2017		10/01/2017
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/13/2021	10/01/2021		10/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/13/2021	10/01/2021		10/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/12/2024	04/01/2024		04/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #48611	141 PREBLE STREET	PORTLAND	ME	04101	01/12/2024	04/01/2024		04/01/2024
Contract Detail	PROCARE PHARMACY, L.L.C.	CVS/PHARMACY #48637	2700 NORTHEAST EXPY NE STE B800 BUILDING B	ATLANTA	GA	30345	01/12/2024	04/01/2024		04/01/2024
Contract Detail	Rite Aid 6811	701 Delran Pkwy		Delran	NJ	08075	04/09/2025	07/01/2025		04/09/2025
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #7924	2270 NOBLESTOWN ROAD	PITTSBURGH	PA	15205	07/12/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2482	300 MARKET STREET	ELIZABETH	PA	15037	07/12/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4783	5100 LIBRARY ROAD	BETHEL PARK	PA	15102	07/12/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1094	3210 BANKSVILLE ROAD	PITTSBURGH	PA	15216	07/12/2023	10/01/2023		10/01/2023
Contract Detail	RX PARTNERS-LTC	500 OLD POND RD STE 406		BRIDGEVILLE	PA	15017	01/14/2020	04/01/2020	04/09/2021	04/09/2021
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/12/2021	01/01/2022		01/01/2022
Contract Detail	SINA DRUG LLC	DBA ONCO360	1985 MARCUS AVE STE 120	NEW HYDE PARK	NY	11042	04/14/2022	07/01/2022		07/01/2022
Contract Detail	THE LANE DRUG COMPANY	RITE AID #2380	975 MARKET STREET	MEADVILLE	PA	16335	07/12/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10967	6090 ROUTE 30	GREENSBURG	PA	15601	07/12/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10996	64 NORTH MERCER AVE.	SHARPSVILLE	PA	16150	07/12/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10910	4927 HOMEVILLE ROAD	WEST MIFFLIN	PA	15122	07/12/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10934	2336 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/12/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10950	568 CASTE VILLAGE	PITTSBURGH	PA	15236	07/12/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10942	410 COOKE LANE	PITTSBURGH	PA	15234	07/12/2023	10/01/2023		10/01/2023
Contract Detail	UPMC CHILDRENS HOSPITAL OF PITTSBURGH	4401 PENN AVE		PITTSBURGH	PA	15224-1334	07/12/2011	07/15/2011	05/14/2021	05/14/2021
Contract Detail	UPMC MAGEE WOMENS HOSPITAL	PHARMACY DEPARTMENT	300 HALKET ST RM 4670	PITTSBURGH	PA	15213	07/12/2011	07/15/2011	07/03/2024	07/03/2024
Contract Detail	UPMC MERCY OUTPATIENT PHARMACY	1622 LOCUST ST		PITTSBURGH	PA	15219	07/03/2024	10/01/2024		10/01/2024
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-1739	30 TRINITY POINT DRIVE		WASHINGTON	PA	15301	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-1948	400 THREE SPRINGS DR		WEIRTON	WV	26062	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-2193	100 MALL DRIVE		STEUBENVILLE	OH	43952	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-2281	2351 CENTURY DR		WEST MIFFLIN	PA	15122	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-2300	250 SUMMIT PARK DR		PITTSBURGH	PA	15275	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-2420	100 SARA WAY/ ROSTRAVER SQUARE		BELLE VERNON	PA	15012	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-2588	100 WAL-MART DRIVE		NORTH VERSAILLES	PA	15137	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-4501	134 DANIEL KENDALL DR		WEST BROWNSVILLE	PA	15417	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-5040	2200 WASHINGTON PIKE		CARNEGIE	PA	15106	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/10/2023	01/01/2024		01/01/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01034	112 W STEUBEN STREET	CRAFTON	PA	15205	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09187	1741 WASHINGTON RD	PITTSBURGH	PA	15241-1201	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09188	4 OLD CLAIRTON RD	PLEASANT HILLS	PA	15236	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09281	5956 CENTRE AVENUE	PITTSBURGH	PA	15206-3830	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09344	2455 LEECHBURG ROAD	NEW KENSINGTON	PA	15068-4619	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09674	133 WEST 8TH AVE	HOMESTEAD	PA	15120-1800	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09675	6201 SALTSBURG ROAD	PITTSBURGH	PA	15235	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	99 JEFFERSON AVE.	WASHINGTON	PA	15301-4434	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	4885 MCKNIGHT RD STE 6 STE 7	PITTSBURGH	PA	15237	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09803	324 HULTON ROAD	OAKMONT	PA	15139-1917	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2055 OLD WASHINGTON PIKE	CARNEGIE	PA	15106	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	7628 PENN AVE.	PITTSBURGH	PA	15221-2114	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	100 RHODE ISLAND AVE.	ROCHESTER	PA	15074-2214	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	100 CAVASINA DR.	CANONSBURG	PA	15317-1767	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	6906 UNIVERSITY BLVD.	MOON TOWNSHIP	PA	15108-4248	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	4900 LIBRARY RD.	BETHEL PARK	PA	15102-2810	07/12/2022	10/01/2022	11/15/2022	07/12/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	4667 WILLIAM PENN HWY.	MURRYSVILLE	PA	15668	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	20260 ROUTE 19	CRANBERRY	PA	16066	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	234 S MAIN STREET	ZELIENOPLE	PA	16063	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	100 E. MCMURRAY RD.	MCMURRAY	PA	15317-2962	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/12/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/10/2023	01/01/2024		01/01/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/10/2023	01/01/2024		01/01/2024

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
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
Details	Last Recertification Date	Update	Recertification	8/26/2023 2:31:53 PM	8/29/2024 2:13:04 PM	8/29/2024 2:13 PM
Addresses	Shipping Address	Update	Change Request	PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. PITTSBURGH, PA 15203	HC PHARMACY CENTRAL 3175 E CARSON ST PITTSBURGH, PA 15203	2/14/2024 8:11 AM
Addresses	Shipping Address	Update	Change Request	UPMC Mercy Health Center Pharmacy 1622 Locust Street Pittsburgh, PA 15219	UPMC MERCY OUTPATIENT PHARMACY 1622 Locust Street Pittsburgh, PA 15219	2/14/2024 8:11 AM
Addresses	Shipping Address	Insert	Change Request		UPMC MERCY PHARMACY 1400 LOCUST ST PITTSBURGH, PA 15219	2/14/2024 8:11 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 2:17:11 PM	8/26/2023 2:31:53 PM	8/26/2023 2:31 PM
Contacts	Authorizing Official	Update	AO Change Request	Deems, Ron Wesley CFO Mercy and Magee UPMC 4125768808	Petrie, Jonathan CFO UPMC Magee and Mercy UPMC 4125789416	6/20/2023 1:49 PM
Addresses	Shipping Address	Update	Change Request	UPMCMercy Health Center Pharmacy 1515 Locust Street Pittsburgh, PA 15219	UPMC Mercy Health Center Pharmacy 1622 Locust Street Pittsburgh, PA 15219	5/2/2023 6:26 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 12:22:51 PM	9/1/2022 2:17:11 PM	9/1/2022 2:17 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1001380890012	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1001380890043	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1001380890017	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100138080044	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1001380890013	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1001380890045	8/23/2022 1:05 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1881695146	8/23/2022 1:05 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1225004047	8/23/2022 1:05 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1639143084	8/23/2022 1:05 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1568526135	8/23/2022 1:05 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 1:05 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 4:40:03 PM	9/10/2021 12:22:51 PM	9/10/2021 12:22 PM
Contacts	Authorizing Official	Update	AO Change Request	Bugni, Richard Director of Finance UPMC Mercy 4128028231	Deems, Ron Wesley CFO Mercy and Magee UPMC 4125768808	1/29/2021 9:23 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1001380890043 (PA)		11/24/2020 3:16 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1001380890042 (PA)		11/24/2020 3:16 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1001380890046 (PA)		11/24/2020 3:16 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1001380890017 (PA)		11/24/2020 3:16 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1881695146 (PA)		11/24/2020 3:16 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1639143084 (PA)		11/24/2020 3:16 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1770645822 ( )		9/10/2020 4:40 PM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/10/2020 4:40 PM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/10/2020 4:40 PM
Details	Last Recertification Date	Update	Recertification	9/3/2019 10:23:27 AM	9/10/2020 4:40:03 PM	9/10/2020 4:40 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/3/2019 10:23 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1001380890042	9/3/2019 10:23 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	9/3/2019 10:23 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1001380890012 (PA)		9/3/2019 10:23 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1770645822	9/3/2019 10:23 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1225004047 ( )		9/3/2019 10:23 AM
Details	Last Recertification Date	Update	Recertification	8/29/2018 3:39:03 PM	9/3/2019 10:23:27 AM	9/3/2019 10:23 AM
Contacts	Authorizing Official	Update	Change Request	Simmons, Eileen CFO Magee Womens Hospital of UPMC 4126477713	Bugni, Richard Director of Finance UPMC Mercy 4128028231	11/19/2018 11:33 AM
Details	Last Recertification Date	Update	Recertification	12/6/2017 7:55:54 AM	8/29/2018 3:39:03 PM	8/29/2018 3:39 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	12/6/2017 7:55:54 AM	12/6/2017 7:55 AM
Contacts	Authorizing Official	Update	AO Change Request	LUTTNER, SANDRA J. VP AND CFO 4122328627	Simmons, Eileen CFO Magee Womens Hospital of UPMC 4126477713	11/21/2017 11:58 AM
Contacts	Primary Contact	Update		Sargent, Andrea DIRECTOR, PHARMACY SERVICES 4122323696	Sargent, Andrea DIRECTOR, PHARMACY SERVICES UPMC Mercy 4122323696	9/29/2017 8:50 AM
Addresses	Main Address	Insert			1400 LOCUST STREET PITTSBURGH, PA 15219	6/20/2017 4:17 PM
Addresses	Billing Address	Insert			PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. PITTSBURGH, PA 15203	6/20/2017 4:17 PM
Addresses	Shipping Address	Insert			PROCUREMENT: H C PHARMACY CENTRAL 3175 EAST CARSON ST. PITTSBURGH, PA 15203	6/20/2017 4:17 PM
Addresses	Shipping Address	Insert			UPMCMercy Health Center Pharmacy 1515 Locust Street Pittsburgh, PA 15219	6/20/2017 4:17 PM
Contacts	Primary Contact	Insert			Sargent, Andrea DIRECTOR, PHARMACY SERVICES 4122323696	6/20/2017 4:17 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	8/23/2016 8:34 AM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 8:34 AM
Details	Last Recertification Date	Update		9/3/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/25/2015 3:26 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	7/30/2015 10:33 AM
Medicaid Billing	Medicaid: Number	Insert			1001380890046	7/30/2015 10:33 AM
Medicaid Billing	Medicaid: State	Insert			PA	7/30/2015 10:33 AM
Details	Last Recertification Date	Update		9/6/2013 12:00:00 AM	9/3/2014 12:00:00 AM	9/3/2014 1:46 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	9/6/2013 12:00:00 AM	9/6/2013 7:53 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	5/21/2012 7:26 AM
Medicaid Billing	Medicaid: Number	Insert			1001380890043	5/21/2012 7:26 AM
Medicaid Billing	Medicaid: State	Insert			PA	5/21/2012 7:26 AM
Medicaid Billing	NPI: Number	Insert			1881695146	5/21/2012 7:26 AM
Medicaid Billing	NPI: Number	Insert			1225004047	5/21/2012 7:26 AM
Medicaid Billing	NPI: Number	Insert			1639143084	5/21/2012 7:26 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/21/2012 7:26 AM
Contacts	Authorizing Official	Insert			LUTTNER, SANDRA J. VP AND CFO 4122328627	11/18/2009 4:43 PM
Details	Last Recertification Date	Insert				11/18/2009 4:43 PM
Details	Grant Number	Insert				11/18/2009 4:43 PM
Details	340B ID	Insert			DSH390028	11/18/2009 4:43 PM
Details	Is Authorizing Official EHB Data	Insert				11/18/2009 4:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				11/18/2009 4:43 PM
Details	Medicare Provider Number	Insert			390028	11/18/2009 4:43 PM
Details	Entity Name	Insert			UPMC MERCY	11/18/2009 4:43 PM
Details	Program Code	Insert			DSH	11/18/2009 4:43 PM
Details	Entity Subname	Insert				11/18/2009 4:43 PM
Dates	Participating Approval Date	Insert			9/2/2008 12:00:00 AM	11/18/2009 4:43 PM
Details	State	Insert			Active	11/18/2009 4:43 PM
Dates	Registration Date	Insert			11/23/2005 12:00:00 AM	11/18/2009 4:43 PM
Dates	Signed By Date	Insert			8/27/2008 12:00:00 AM	11/18/2009 4:43 PM
Dates	Start Date	Insert			9/2/2008 12:00:00 AM	11/18/2009 4:43 PM
Terminations	Termination Comments	Insert				11/18/2009 4:43 PM
Terminations	Termination Date	Insert				11/18/2009 4:43 PM
Terminations	Termination Effective Date	Insert				11/18/2009 4:43 PM
Terminations	Termination Reason	Insert				11/18/2009 4:43 PM
Details	Comments Public	Insert			9/1/09-DOC RECD TO CONFIRM ELIG DSH ADJ %; 9/17/08-ADDED BILL&SHIPPING ADDRESS; ORIG PART FROM 11/25/05 TO 3/31/08, NOT ELIG FROM 4/1/08 THRU 9/1/08, 9/2/08 NAME CHANGE (WAS PITTSBURGH MERCY HEALTH SYSTEM), MED # CHANGE (WAS 1001380890042)	11/18/2009 4:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	11/23/2005 6:56 AM
Medicaid Billing	Medicaid: Number	Insert			1001380890012	11/23/2005 6:56 AM
Medicaid Billing	Medicaid: State	Insert			PA	11/23/2005 6:56 AM
Medicaid Billing	Medicaid: Is Primary	Insert			True	11/23/2005 6:56 AM
Medicaid Billing	Medicaid: Number	Insert			1001380890017	11/23/2005 6:56 AM
Medicaid Billing	Medicaid: State	Insert			PA	11/23/2005 6:56 AM