Covered Entity Details

PED393302-23 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (Terminated) - information as of 5/20/2025 11:42:53 PM

Main Details

Name

UPMC CHILDREN'S HOSPITAL OF PITTSBURGH

Subdivision Name

East Satellite/Audiology

Type

Children's Hospital

Rural

340B ID

PED393302-23

Medicare Provider Number

393302

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/28/2014

Participating Start Date

1/1/2015

Participating Approval Date

12/8/2014

Last Recertification Date

9/1/2020

Termination Date
Termination Reason

10/1/2021
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

UPMC
Mario Edward Wilfong, CFO
(412) 692-8201

Primary Contact

Children's Hospital of Pittsburgh of UPMC
Anthony Patterson, Director of Pharmacy
(412) 692-6242

Addresses

Street Address

4055 Monroeville Boulevard
Monroeville, PA 15146

Billing Address

HC PHARMACY CENTRAL – PROCUREMENT
3175 E. CARSON ST
Pittsburgh, PA 15203

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?
No

Shipping Addresses

Shipping Address 1

HC PHARMACY CENTRAL – PROCUREMENT
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
PED393302-01	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	Outpatient Surgery	2599 WEXFORD BAYNE ROAD	SEWICKLEY	PA	Terminated
PED393302-02	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	SOUTH SATELLITE	205 Millers Run Road	BRIDGEVILLE	PA	Terminated
PED393302-03	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	SAME DAY SURGERY-MAIN HOSPITAL (SPU)	4401 PENN AVENUE	PITTSBURGH	PA	Terminated
PED393302-04	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	EAST SATELLITE	4055 MONROEVILLE BLVD.	MONROEVILLE	PA	Terminated
PED393302-05	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	RENAL CLINIC	4401 PENN AVENUE	PITTSBURGH	PA	Terminated
PED393302-06	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Communication Disorders	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-07	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Phlebotomy Services	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-08	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Radiology Diagnostic	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-09	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Occupational Therapy	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-10	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Physical Therapy	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-11	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Pulmonary Function	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-12	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Electroencephalography	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-13	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/EKG / ECHO	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-14	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Audiology	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-15	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Electroencephalography	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-16	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Phlebotomy Services	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-17	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Pulmonary Function	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-18	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/EKG / ECHO	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-19	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Occupational Therapy	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-20	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Physical Therapy	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-21	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Radiology Diagnostic	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-22	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Communication Disorders	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-23	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Audiology	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-24	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Ronald McDonald Care Mobile	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-25	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Phlebotomy Services	11279 Perry Highway	Wexford	PA	Terminated
PED393302-26	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Electromyography	11279 Perry Highway	Wexford	PA	Terminated
PED393302-27	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Electroencephalography	11279 Perry Highway	Wexford	PA	Terminated
PED393302-28	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Child & Family Counseling	11279 Perry Highway	Wexford	PA	Terminated
PED393302-29	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Communication Disorders	11279 Perry Highway	Wexford	PA	Terminated
PED393302-30	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Occupational Therapy	11279 Perry Highway	Wexford	PA	Terminated
PED393302-31	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Sleep Study Center	2619 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-32	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Pulmonary Function	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-33	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Phlebotomy Services	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-34	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/EKG / ECHO	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-35	Child	PED	CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC	North Satellite/MRI	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-36	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Radiology Diagnostic	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-37	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Audiology	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-38	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Surgery Center	2599 Wexford-Bayne Road	Sewickley	PA	Active
PED393302-39	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Physical Therapy	11279 Perry Highway	Wexford	PA	Terminated
PED393302-40	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	CHP-Pulmonology North - (31315)	2599 Wexford-Bayne Road	Wexford	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2021 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		12/15/2020 12:00:00 AM	9/10/2021 11:12 AM
Details	State	Update	Recertification	Active	To Be Terminated	9/10/2021 11:12 AM
Terminations	Termination Comments	Update	Recertification		No drug used at facility.	9/10/2021 11:12 AM
Terminations	Termination Date	Update	Recertification		10/1/2021 12:00:00 AM	9/10/2021 11:12 AM
Terminations	Termination Effective Date	Update	Recertification		12/15/2020 12:00:00 AM	9/10/2021 11:12 AM
Terminations	Termination Reason	Update	Recertification		Hospital Outpatient facility no longer eligible	9/10/2021 11:12 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007347990059 (PA)		11/30/2020 3:27 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1053476556 (PA)		11/30/2020 3:27 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1083851968 (PA)		11/30/2020 3:27 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1194889485 (PA)		11/30/2020 3:27 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1164426896 (PA)		11/30/2020 3:27 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1053476556	9/1/2020 10:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 10:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1083851968	9/1/2020 10:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 10:13 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1194889485	9/1/2020 10:13 AM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/1/2020 10:13 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/1/2020 10:13 AM
Details	Last Recertification Date	Update	Recertification	9/4/2019 9:56:36 AM	9/1/2020 10:13:54 AM	9/1/2020 10:13 AM
Contacts	Authorizing Official	Update	Change Request	BARCELLONA, NICHOLAS CFO Children's Hospital of Pittsburgh of UPMC 4126927331	Wilfong, Mario Edward CFO UPMC 4126928201	6/15/2020 1:11 PM
Addresses	Billing Address	Insert	Recertification		HC PHARMACY CENTRAL – PROCUREMENT 3175 E. CARSON ST Pittsburgh, PA 15203	9/4/2019 9:56 AM
Details	Last Recertification Date	Update	Recertification	8/31/2018 11:42:21 AM	9/4/2019 9:56:36 AM	9/4/2019 9:56 AM
Details	Entity Name	Update	Recertification	CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	9/7/2018 12:33 PM
Details	Last Recertification Date	Update	Recertification	11/27/2017 2:26:08 PM	8/31/2018 11:42:21 AM	8/31/2018 11:42 AM
Contacts	Primary Contact	Insert	Recertification		Patterson, Anthony Director of Pharmacy Children's Hospital of Pittsburgh of UPMC 4126926242	11/27/2017 2:26 PM
Details	Last Recertification Date	Update	Recertification	8/30/2016 12:00:00 AM	11/27/2017 2:26:08 PM	11/27/2017 2:26 PM
Contacts	Authorizing Official	Update		BARCELLONA, NICHOLAS CFO 4126927331	BARCELLONA, NICHOLAS CFO Children's Hospital of Pittsburgh of UPMC 4126927331	10/10/2017 1:02 PM
Contacts	Signed By	Update		BARCELLONA, NICHOLAS CFO 4126927331	BARCELLONA, NICHOLAS CFO Children's Hospital of Pittsburgh of UPMC 4126927331	10/10/2017 1:02 PM
Contacts	Authorizing Official	Insert			BARCELLONA, NICHOLAS CFO 4126927331	7/13/2017 2:06 PM
Contacts	Signed By	Insert			BARCELLONA, NICHOLAS CFO 4126927331	7/13/2017 2:06 PM
Details	Last Recertification Date	Update		8/21/2015 12:00:00 AM	8/30/2016 12:00:00 AM	8/30/2016 8:22 AM
Addresses	Main Address	Insert			4055 Monroeville Boulevard Monroeville, PA 15146	8/30/2016 8:22 AM
Details	Last Recertification Date	Update			8/21/2015 12:00:00 AM	8/21/2015 10:11 AM
Addresses	Shipping Address	Insert			HC PHARMACY CENTRAL – PROCUREMENT 3175 E. CARSON ST Pittsburgh, PA 15203	12/8/2014 7:08 PM
Details	Entity Subname	Update		East Satellite	East Satellite/Audiology	12/8/2014 6:53 PM
Dates	Participating Approval Date	Update			12/8/2014 12:00:00 AM	12/8/2014 6:53 PM
Details	State	Update		Pending	Active	12/8/2014 6:53 PM
Dates	Start Date	Update			1/1/2015 12:00:00 AM	12/8/2014 6:53 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_47796	PED393302-23	11/3/2014 8:29 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_47796	10/28/2014 3:43 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	10/28/2014 3:43 PM
Medicaid Billing	Medicaid: Number	Insert			1007347990059	10/28/2014 3:43 PM
Medicaid Billing	Medicaid: State	Insert			PA	10/28/2014 3:43 PM
Medicaid Billing	NPI: Number	Insert			1164426896	10/28/2014 3:43 PM
Details	Last Recertification Date	Insert				10/28/2014 3:43 PM
Details	Grant Number	Insert				10/28/2014 3:43 PM
Details	340B ID	Insert				10/28/2014 3:43 PM
Details	Is Authorizing Official EHB Data	Insert				10/28/2014 3:43 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/28/2014 3:43 PM
Details	Medicare Provider Number	Insert			393302	10/28/2014 3:43 PM
Details	Entity Name	Insert			CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC	10/28/2014 3:43 PM
Details	Program Code	Insert			PED	10/28/2014 3:43 PM
Details	Entity Subname	Insert			East Satellite	10/28/2014 3:43 PM
Dates	Participating Approval Date	Insert				10/28/2014 3:43 PM
Details	State	Insert			Pending	10/28/2014 3:43 PM
Dates	Registration Date	Insert			10/28/2014 12:00:00 AM	10/28/2014 3:43 PM
Dates	Signed By Date	Insert			10/28/2014 12:00:00 AM	10/28/2014 3:43 PM
Dates	Start Date	Insert				10/28/2014 3:43 PM
Terminations	Termination Comments	Insert				10/28/2014 3:43 PM
Terminations	Termination Date	Insert				10/28/2014 3:43 PM
Terminations	Termination Effective Date	Insert				10/28/2014 3:43 PM
Terminations	Termination Reason	Insert				10/28/2014 3:43 PM