Covered Entity Details

DSH390073A ALTOONA REGIONAL HEALTH SYSTEM (Terminated) - information as of 6/6/2025 12:37:34 PM

Main Details

Name

ALTOONA REGIONAL HEALTH SYSTEM

Subdivision Name

University Pittsburgh Medical Center -ALTOONA / Health Force

Type

Disproportionate Share Hospital

Rural

340B ID

DSH390073A

Medicare Provider Number

390073

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

4/3/2017

Participating Start Date

7/1/2017

Participating Approval Date

4/26/2017

Last Recertification Date

Termination Date
Termination Reason

1/1/2018
DSH percentage below statutory minimum

Contacts

Authorizing Official

UPMC Altoona
Monica J Klatt, Chief Financial Officer
(814) 889-2223

Primary Contact

UPMC Altoona
Jill Breton, Director of Pharmacy
(814) 889-2825

Addresses

Street Address

1516 9TH AVE
UPMC ALTOONA STATION MEDICAL CENTER
ALTOONA, PA 16602-2417

Billing Address

HC Pharmacy Central-Procurement
3175 East Carson Street
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?
Yes

State	Medicaid Number	NPI Number
PA	10007278290084
		1649278730

Shipping Addresses

Shipping Address 1

HC Pharmacy Central-Procurement
3175 East Carson Street
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
DSH390073A	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center -ALTOONA / Health Force	1516 9TH AVE	ALTOONA	PA	Terminated
DSH390073B	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center ALTOONA / MRI	1516 9TH AVE	ALTOONA	PA	Active
DSH390073C	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center ALTOONA / CT Scanner	1516 9TH AVE	ALTOONA	PA	Active
DSH390073D	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center ALTOONA / Ultrasound	1516 9TH AVE	ALTOONA	PA	Active
DSH390073E	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center ALTOONA / Radiology	1516 9TH AVE	ALTOONA	PA	Active
DSH390073F	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center HUNTINGDON FAMILY PHYSICIANS	9498 WILLIAM PENN HIGHWAY	HUNTINGDON	PA	Terminated
DSH390073G	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	UPMC ALTOONA PREGNANCY CARE CENTER	501 HOWARD AVE, BUILDING F, SUITE 5	ALTOONA	PA	Active
DSH390073H	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	Altoona Family Physicians. FAMILY CENTERED OB GYN	501 HOWARD AVE STE F2	ALTOONA	PA	Terminated
DSH390073J	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center ALTOONA SURGERY CENTER	800 HOWARD AVENUE	ALTOONA	PA	Active
DSH390073K	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center ALTOONA FAMILY PHYSICIANS	501 HOWARD AVE, BUILDING F, SUITE 2	ALTOONA	PA	Active
DSH390073L	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	University Pittsburgh Medical Center WILLIAMSBURG FAMILY PRACTICE	306 PLUM ST	WILLIAMSBURG	PA	Active
DSH390073M	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	UPMC Hillman Cancer Center part of UPMC Altoona - HBC Medical Oncology	800 Howard Avenue Suite 1	Altoona	PA	Active
DSH390073N	Child	DSH	ALTOONA REGIONAL HEALTH SYSTEM	JOHN P MURTHA REGIONAL CANCER CENT - ALTNA-Murtha HBC	337 SOMERSET ST	JOHNSTOWN	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Wilfong, Mario Edward CFO UPMC 4126928201	Klatt, Monica J Chief Financial Officer UPMC Altoona 8148892223	6/12/2020 1:05 PM
Contacts	Authorizing Official	Update	Profile Change Request	Wilfong, Mario Edward CFO UPMC 8148892223	Wilfong, Mario Edward CFO UPMC 4126928201	6/12/2020 12:46 PM
Contacts	Signed By	Update	Profile Change Request	Wilfong, Mario Edward CFO UPMC 8148892223	Wilfong, Mario Edward CFO UPMC 4126928201	6/12/2020 12:46 PM
Contacts	Primary Contact	Update	Reinstatement	Breton, Jill Director of Pharmacy 8148892825	Breton, Jill Director of Pharmacy UPMC Altoona 8148892825	7/12/2018 9:19 AM
Details	State	Update		To Be Terminated	Terminated	1/1/2018 12:00 AM
Dates	Last Date That 340B Drugs Purchased	Update	Recertification		11/7/2017 12:00:00 AM	11/8/2017 1:54 PM
Details	State	Update	Recertification	Active	To Be Terminated	11/8/2017 1:54 PM
Terminations	Termination Date	Update	Recertification		1/1/2018 12:00:00 AM	11/8/2017 1:54 PM
Terminations	Termination Effective Date	Update	Recertification		11/7/2017 12:00:00 AM	11/8/2017 1:54 PM
Terminations	Termination Reason	Update	Recertification		DSH percentage below statutory minimum	11/8/2017 1:54 PM
Contacts	Authorizing Official	Update		Wilfong, Mario CFO 8148892223	Wilfong, Mario Edward CFO UPMC 8148892223	10/23/2017 8:35 PM
Contacts	Signed By	Update		Wilfong, Mario CFO 8148892223	Wilfong, Mario Edward CFO UPMC 8148892223	10/23/2017 8:35 PM
Addresses	Main Address	Insert			1516 9TH AVE UPMC ALTOONA STATION MEDICAL CENTER ALTOONA, PA 16602-2417	5/11/2017 5:29 PM
Addresses	Billing Address	Insert			HC Pharmacy Central-Procurement 3175 East Carson Street Pittsburgh, PA 15203	5/11/2017 5:29 PM
Addresses	Shipping Address	Insert			HC Pharmacy Central-Procurement 3175 East Carson Street Pittsburgh, PA 15203	5/11/2017 5:29 PM
Contacts	Primary Contact	Insert			Breton, Jill Director of Pharmacy 8148892825	5/11/2017 5:29 PM
Contacts	Authorizing Official	Insert			Wilfong, Mario CFO 8148892223	5/11/2017 5:29 PM
Contacts	Signed By	Insert			Wilfong, Mario CFO 8148892223	5/11/2017 5:29 PM
Dates	Participating Approval Date	Update			4/26/2017 12:00:00 AM	4/26/2017 11:06 AM
Details	State	Update		Pending	Active	4/26/2017 11:06 AM
Dates	Start Date	Update			7/1/2017 12:00:00 AM	4/26/2017 11:06 AM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_75834	DSH390073A	4/4/2017 9:04 AM
Details	Entity Subname	Update		UPMC ALTOONA / Health Force	University Pittsburgh Medical Center -ALTOONA / Health Force	4/4/2017 9:04 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_75834	4/3/2017 4:54 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/3/2017 4:54 PM
Medicaid Billing	Medicaid: Number	Insert			10007278290084	4/3/2017 4:54 PM
Medicaid Billing	Medicaid: State	Insert			PA	4/3/2017 4:54 PM
Medicaid Billing	NPI: Number	Insert			1649278730	4/3/2017 4:54 PM
Details	Last Recertification Date	Insert				4/3/2017 4:54 PM
Details	Grant Number	Insert				4/3/2017 4:54 PM
Details	340B ID	Insert				4/3/2017 4:54 PM
Details	Is Authorizing Official EHB Data	Insert				4/3/2017 4:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/3/2017 4:54 PM
Details	Medicare Provider Number	Insert			390073	4/3/2017 4:54 PM
Details	Entity Name	Insert			ALTOONA REGIONAL HEALTH SYSTEM	4/3/2017 4:54 PM
Details	Program Code	Insert			DSH	4/3/2017 4:54 PM
Details	Entity Subname	Insert			UPMC ALTOONA / Health Force	4/3/2017 4:54 PM
Dates	Participating Approval Date	Insert				4/3/2017 4:54 PM
Details	State	Insert			Pending	4/3/2017 4:54 PM
Dates	Registration Date	Insert			4/3/2017 12:00:00 AM	4/3/2017 4:54 PM
Dates	Signed By Date	Insert			4/3/2017 12:00:00 AM	4/3/2017 4:54 PM
Dates	Start Date	Insert				4/3/2017 4:54 PM
Terminations	Termination Comments	Insert				4/3/2017 4:54 PM
Terminations	Termination Date	Insert				4/3/2017 4:54 PM
Terminations	Termination Effective Date	Insert				4/3/2017 4:54 PM
Terminations	Termination Reason	Insert				4/3/2017 4:54 PM