Covered Entity Details

DSH390063B UPMC HAMOT (Active) - information as of 6/24/2025 3:07:20 AM

Main Details

Name

UPMC HAMOT

Subdivision Name

UPMC HAMOT INFUSION CENTER (36118)

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390063B

Medicare Provider Number

390063

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/11/2015

Participating Start Date

4/1/2015

Participating Approval Date

3/4/2015

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

UPMC Hamot
Brad N Dinger, CFO
(814) 877-3739

Primary Contact

UPMC
Amanda Pell, Manager, 340B Program
(814) 771-8354

Addresses

Street Address

215 HOLLAND ST
ERIE, PA 16507-1526

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	100728657,1007286570033,1007286570045,1007286570026	1487647590,1538207394,1730431628

Shipping Addresses

Shipping Address 1

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

Shipping Address 2

HC Pharmacy Central
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
DSH390063A	Child	DSH	UPMC HAMOT	Wound Center (34202)	215 Holland Street	Erie	PA	Active
DSH390063B	Child	DSH	UPMC HAMOT	UPMC HAMOT INFUSION CENTER (36118)	215 HOLLAND ST	ERIE	PA	Active
DSH390063C	Child	DSH	UPMC HAMOT	UPMC HAMOT - Hamot NICU Clinic (22001)	118 EAST 2ND STREET	ERIE	PA	Active
DSH390063D	Child	DSH	UPMC HAMOT	UPMC HAMOT - Recovery Room	118 EAST 2ND STREET	ERIE	PA	Terminated
DSH390063E	Child	DSH	UPMC HAMOT	Hamot RRC Injection Suite (33352)	2500 West 12th Street	Erie	PA	Active
DSH390063F	Child	DSH	UPMC HAMOT	UPMC HAMOT - Operating Room	118 EAST 2ND STREET	ERIE	PA	Terminated
DSH390063G	Child	DSH	UPMC HAMOT	UPMC HAMOT - Hamot-OB Triage (34711)	118 EAST 2ND STREET	ERIE	PA	Active
DSH390063H	Child	DSH	UPMC HAMOT	UPMC HAMOT - Labor and Delivery (21401)	118 EAST 2ND STREET	ERIE	PA	Active
DSH390063J	Child	DSH	UPMC HAMOT	HAMOT-Breast Imaging - (32664)	300 State Street	Erie	PA	Active
DSH390063K	Child	DSH	UPMC HAMOT	HAMOT-MRI - (32666)	120 East Second Street	Erie	PA	Active
DSH390063L	Child	DSH	UPMC HAMOT	HAMOT-Mammography - (32662)	300 State Street	Erie	PA	Active
DSH390063M	Child	DSH	UPMC HAMOT	HAMOT-Heart Institute - (30124)	120 East Second Street	Erie	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Insert	Group Change Request		HC Pharmacy Central 3175 E Carson St Pittsburgh, PA 15203	5/29/2025 1:31 PM
Contacts	Primary Contact	Update	Group Change Request	Camp, William Zacharie 340B Manager UPMC Presbyterian Shadyside 7406060376	Pell, Amanda Manager, 340B Program UPMC 8147718354	5/6/2025 12:18 PM
Addresses	Billing Address	Update	Group Change Request	HC PHARMACY CENTRAL-PROCUREMENT 3175 E. CARSON ST. PITTSBURGH, PA 15203	UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain PO Box 2058 Portland, OR 97208	5/6/2025 12:12 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 12:12 PM
Addresses	Shipping Address	Delete	Group Change Request	HC PHARMACY CENTRAL 3175 E CARSON ST PITTSBURGH, PA 15203		5/6/2025 12:12 PM
Contacts	Primary Contact	Update	Group Change Request	Kuneman, Michael Director, Pharmacy UPMC Hamot 8148772527	Camp, William Zacharie 340B Manager UPMC Presbyterian Shadyside 7406060376	10/23/2024 2:26 PM
Details	Last Recertification Date	Update	Recertification	8/22/2023 12:55:10 PM	9/6/2024 1:18:24 PM	9/6/2024 1:18 PM
Addresses	Shipping Address	Update	Change Request	HC PHARMACY CENTRAL - PROCUREMENT 3175 E. CARSON ST PITTSBURGH, PA 15203	HC PHARMACY CENTRAL 3175 E CARSON ST PITTSBURGH, PA 15203	2/12/2024 12:29 PM
Details	Entity Subname	Update	Change Request	UPMC HAMOT INFUSION CENTER	UPMC HAMOT INFUSION CENTER (36118)	2/5/2024 2:41 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 1:45:30 PM	8/22/2023 12:55:10 PM	8/22/2023 12:55 PM
Contacts	Primary Contact	Update	Profile Change Request	Kuneman, Michael Pharmacy Manager UPMC Hamot 8148772527	Kuneman, Michael Director, Pharmacy UPMC Hamot 8148772527	8/16/2023 2:28 PM
Details	Last Recertification Date	Update	Recertification	9/13/2021 12:41:59 PM	8/29/2022 1:45:30 PM	8/29/2022 1:45 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007286570033	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007286570045	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007286570026	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 1:10 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1730431628	8/23/2022 1:10 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 1:10 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/22/2022 9:39 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100728657	8/22/2022 9:39 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/22/2022 9:39 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1487647590	8/22/2022 9:39 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/22/2022 9:39 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1538207394	8/22/2022 9:39 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/22/2022 9:39 AM
Details	Last Recertification Date	Update	Recertification	9/1/2020 1:20:49 PM	9/13/2021 12:41:59 PM	9/13/2021 12:41 PM
Contacts	Primary Contact	Update	Group Change Request	Kumeman, Michael Pharmacy Manager UPMC Hamot 8148772527	Kuneman, Michael Pharmacy Manager UPMC Hamot 8148772527	7/30/2021 1:42 PM
Contacts	Primary Contact	Update	Change Request	Belavic, Jennifer Director of Pharmacy UPMC Hamot 8148772710	Kumeman, Michael Pharmacy Manager UPMC Hamot 8148772527	12/8/2020 12:39 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007286570033 (PA)		11/25/2020 9:03 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1487647590 (PA)		11/25/2020 9:03 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/1/2020 1:20 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 11:50:28 AM	9/1/2020 1:20:49 PM	9/1/2020 1:20 PM
Addresses	Billing Address	Insert	Recertification		HC PHARMACY CENTRAL-PROCUREMENT 3175 E. CARSON ST. PITTSBURGH, PA 15203	9/5/2019 11:50 AM
Details	Last Recertification Date	Update	Recertification	9/5/2018 11:45:02 AM	9/5/2019 11:50:28 AM	9/5/2019 11:50 AM
Details	Last Recertification Date	Update	Recertification	12/1/2017 9:32:40 AM	9/5/2018 11:45:02 AM	9/5/2018 11:45 AM
Contacts	Authorizing Official	Update	Change Request	Danch, Stephen Mark CFO UPMC Hamot 8148776162	Dinger, Brad N CFO UPMC Hamot 8148773739	6/14/2018 12:49 PM
Details	Last Recertification Date	Update	Recertification	8/23/2016 12:00:00 AM	12/1/2017 9:32:40 AM	12/1/2017 9:32 AM
Contacts	Authorizing Official	Update		Danch, Stephen CFO 8148776162	Danch, Stephen Mark CFO UPMC Hamot 8148776162	10/10/2017 2:03 PM
Contacts	Signed By	Update		Danch, Stephen CFO 8148776162	Danch, Stephen Mark CFO UPMC Hamot 8148776162	10/10/2017 2:03 PM
Contacts	Primary Contact	Update		Belavic, Jennifer Director of Pharmacy 8148772710	Belavic, Jennifer Director of Pharmacy UPMC Hamot 8148772710	9/29/2017 12:38 PM
Contacts	Primary Contact	Update		Thompson, Thomas VP, Pharmacy Services 8148172710	Belavic, Jennifer Director of Pharmacy 8148772710	6/21/2017 8:55 AM
Contacts	Authorizing Official	Insert			Danch, Stephen CFO 8148776162	6/21/2017 8:55 AM
Contacts	Signed By	Insert			Danch, Stephen CFO 8148776162	6/21/2017 8:55 AM
Addresses	Main Address	Insert			215 HOLLAND ST ERIE, PA 16507-1526	6/21/2017 8:54 AM
Addresses	Shipping Address	Insert			HC PHARMACY CENTRAL - PROCUREMENT 3175 E. CARSON ST PITTSBURGH, PA 15203	6/21/2017 8:54 AM
Contacts	Primary Contact	Insert			Thompson, Thomas VP, Pharmacy Services 8148172710	8/23/2016 1:09 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/23/2016 12:00:00 AM	8/23/2016 1:09 PM
Details	Last Recertification Date	Update			8/19/2015 12:00:00 AM	8/19/2015 9:14 AM
Dates	Participating Approval Date	Update			3/4/2015 12:00:00 AM	3/4/2015 4:21 PM
Details	State	Update		Pending	Active	3/4/2015 4:21 PM
Dates	Start Date	Update			4/1/2015 12:00:00 AM	3/4/2015 4:21 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_48595	DSH390063B	1/13/2015 1:12 PM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_48595	1/11/2015 11:34 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/11/2015 11:34 AM
Medicaid Billing	Medicaid: Number	Insert			1007286570033	1/11/2015 11:34 AM
Medicaid Billing	Medicaid: State	Insert			PA	1/11/2015 11:34 AM
Medicaid Billing	NPI: Number	Insert			1487647590	1/11/2015 11:34 AM
Details	Last Recertification Date	Insert				1/11/2015 11:34 AM
Details	Grant Number	Insert				1/11/2015 11:34 AM
Details	340B ID	Insert				1/11/2015 11:34 AM
Details	Is Authorizing Official EHB Data	Insert				1/11/2015 11:34 AM
Dates	Last Date That 340B Drugs Purchased	Insert				1/11/2015 11:34 AM
Details	Medicare Provider Number	Insert			390063	1/11/2015 11:34 AM
Details	Entity Name	Insert			UPMC HAMOT	1/11/2015 11:34 AM
Details	Program Code	Insert			DSH	1/11/2015 11:34 AM
Details	Entity Subname	Insert			UPMC HAMOT INFUSION CENTER	1/11/2015 11:34 AM
Dates	Participating Approval Date	Insert				1/11/2015 11:34 AM
Details	State	Insert			Pending	1/11/2015 11:34 AM
Dates	Registration Date	Insert			1/11/2015 12:00:00 AM	1/11/2015 11:34 AM
Dates	Signed By Date	Insert			1/11/2015 12:00:00 AM	1/11/2015 11:34 AM
Dates	Start Date	Insert				1/11/2015 11:34 AM
Terminations	Termination Comments	Insert				1/11/2015 11:34 AM
Terminations	Termination Date	Insert				1/11/2015 11:34 AM
Terminations	Termination Effective Date	Insert				1/11/2015 11:34 AM
Terminations	Termination Reason	Insert				1/11/2015 11:34 AM