Covered Entity Details

DSH390164 UPMC - PRESBYTERIAN SHADYSIDE (Active) - information as of 4/29/2025 1:37:53 AM

Main Details

Name

UPMC - PRESBYTERIAN SHADYSIDE

Subdivision Name

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390164

Medicare Provider Number

390164

Additional Details

Current Program Status

Active

Registration Date

1/8/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/25/2020

Last Recertification Date

9/3/2024

Contacts

Authorizing Official

UPMC Aids Center for Treatment
Jared Weiner, CFO, UPMC Presbyterian Shadyside
(412) 864-7000

Primary Contact

UPMC Presbyterian Shadyside
William Zacharie Camp, 340B Manager
(740) 606-0376

Addresses

Street Address

200 LOTHROP STREET
PITTSBURGH, PA 15213

Billing Address

HC Pharmacy Central
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	1000019040029,1000019040136,100001904	1821007881,1306855366,1053471656,1144384082,1750390134,1518089200,1164544755,1790945830

Shipping Addresses

Shipping Address 1

HC Pharmacy Central
3175 E Carson Street
Pittsburgh, PA 15203

Shipping Address 2

UPMC PRESBYTERIAN SHADYSIDE
5230 CENTRE AVE
PITTSBURGH, PA 15232

Shipping Address 3

WESTERN PSYCH INST AND CLINIC
3811 OHARA ST
PHARMACY ROOM 15TH FLOOR
PITTSBURGH, PA 15213

Shipping Address 4

Montefiore Campus
3459 Fifth Avenue
Pittsburgh, PA 15213

Shipping Address 5

UPMC PRESBYTERIAN SHADYSIDE
200 LOTHROP ST
DESOTO AT OHARA STREETS
PITTSBURGH, PA 15213

Shipping Address 6

SAFECOR HEALTH
4060 BUSINESS PARK DR
Columbus, OH 43204

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	07/13/2022	10/01/2022		10/01/2022
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/13/2022	10/01/2022		10/01/2022
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/13/2022	10/01/2022		10/01/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/13/2022	10/01/2022	07/02/2024	07/02/2024
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/13/2022	10/01/2022		10/01/2022
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/13/2022	10/01/2022		10/01/2022
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CHARTWELL PENNSYLVANIA	1001 OAKDALE RD		OAKDALE	PA	15071-1502	02/25/2020	04/01/2020		04/01/2020
Contract Detail	CORAM ALTERNATE SITE SERVICES, INC.	DBA CORAM CVS/SPECIALTY INFUSION SERVICE	6 SPRING MILL DR	MALVERN	PA	19355	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/15/2021	10/01/2021		10/01/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	07/15/2020	10/01/2020		10/01/2020
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	ECKERD CORPORATION	RITE AID #10987	100 SEVEN FIELDS BLVD	SEVEN FIELDS	PA	16046	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ECKERD CORPORATION	RITE AID #10929	3730 BRIGHTON ROAD	PITTSBURGH	PA	15212	07/17/2023	10/01/2023		10/01/2023
Contract Detail	ECKERD CORPORATION	RITE AID #10808	4937 TRANSIT ROAD	DEPEW	NY	14043	07/17/2023	10/01/2023		10/01/2023
Contract Detail	FALK PHARMACY	3601 5TH AVE STE 211		PITTSBURGH	PA	15213-3403	02/25/2020	04/01/2020		04/01/2020
Contract Detail	FORBES PHARMACY	3501 FORBES AVE	ROOM 756	PITTSBURGH	PA	15213	02/25/2020	04/01/2020		04/01/2020
Contract Detail	GIANT EAGLE PHARMACY #0017	6401 PENN AVE		PITTSBURGH	PA	15206	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #0018	1671 BUTLER PLANK		GLENSHAW	PA	15116	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0019	1233 BROAD ST		JOHNSTOWN	PA	15906	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #0040	5550 CENTRE AVE		PITTSBURGH	PA	15232	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #0040	5550 CENTRE AVE		PITTSBURGH	PA	15232	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0060	4010 MONROEVILLE BLVD.		MONROEVILLE	PA	15146	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0063	4250 MURRAY AVENUE		PITTSBURGH	PA	15217	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0064	3812 O'NEIL BLVD		MCKEESPORT	PA	15132	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #0072	910 FREEPORT ROAD		PITTSBURGH	PA	15238	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0078	230 RODI ROAD		PITTSBURGH	PA	15235	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #0098	581 PITTSBURGH RD		UNIONTOWN	PA	15401	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #0221	20160 CENTER RIDGE ROAD, SUITE 201		ROCKY RIVER	OH	44116	07/15/2021	10/01/2021	09/29/2024	04/10/2025
Contract Detail	GIANT EAGLE PHARMACY #1220	2001 LINCOLN WAY		WHITE OAK	PA	15131	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #1619	EDGEWOOD TOWNE CENTER	1705 SOUTH BRADDOCK AVE	PITTSBURGH	PA	15218	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #1619	EDGEWOOD TOWNE CENTER	1705 SOUTH BRADDOCK AVE	PITTSBURGH	PA	15218	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #2404	200 ALLEGHENY RIVER BLVD		VERONA	PA	15147	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #6379	420 EAST WATERFRONT DRIVE		HOMESTEAD	PA	15120	07/15/2021	10/01/2021		10/01/2021
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	07/15/2020	10/01/2020	04/12/2021	04/12/2021
Contract Detail	GIANT EAGLE PHARMACY #8991	2500 LOVI RD		FREEDOM	PA	15042	07/15/2021	10/01/2021		10/01/2021
Contract Detail	HILLMAN CENTER PHARMACY	5115 CENTRE AVE RM AG30.1		PITTSBURGH	PA	15232	02/25/2020	04/01/2020		04/01/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03418	1101 ROYAL PALM BEACH BLVD.	ROYAL PALM BEACH	FL	33411	10/11/2023	01/01/2024		01/01/2024
Contract Detail	NORTH CAROLINA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06405	300 EAST GROVER ST	SHELBY	NC	28150	10/11/2023	01/01/2024		01/01/2024
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	10/13/2021	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	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02348	3422 FORBES AVENUE	PITTSBURGH	PA	15213	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04152	5600 WILKINS AVE	PITTSBURGH	PA	15217	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05890	3893 WILLIAM PENN HWY	MONROEVILLE	PA	15146	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07611	4849 WILLIAM FLYNN HIGHWAY	ALLISON PARK	PA	15101	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17618	6231 PENN AVE	PITTSBURGH	PA	15206	07/15/2021	10/01/2021		10/01/2021
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04133	520 PENN AVE	WILKINSBURG	PA	15221	07/15/2021	10/01/2021	10/11/2022	10/11/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04085	6100 PENN AVE.	PITTSBURGH	PA	15206	07/15/2021	10/01/2021	10/01/2021	04/18/2023
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 00258	5703 STEUBENVILLE PIKE	MC KEES ROCKS	PA	15136	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 01682	644 EAST PENN STREET	BEDFORD	PA	15522	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02333	5242 CLAIRTON BOULEVARD	PITTSBURGH	PA	15236	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02447	5190 LIBRARY ROAD	BETHEL PARK	PA	15102	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 02449	11240 PERRY HIGHWAY	WEXFORD	PA	15090	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03165	95 FREEPORT ST	NEW KENSINGTON	PA	15068	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03189	510 BROOKLINE BLVD.	PITTSBURGH	PA	15226	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03999	401 CHESTNUT STREET	CARNEGIE	PA	15106	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04000	2501 WARREN RD	INDIANA	PA	15701	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04003	311 5TH AVE	MCKEESPORT	PA	15132	10/13/2021	01/01/2022	07/13/2022	07/13/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04008	242-250 FIFTH AVE	PITTSBURGH	PA	15222	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04013	200 EAST PLANK RD.	ALTOONA	PA	16602	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04029	1181 FREEDOM RD.	CRANBERRY TWP	PA	16066	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04045	1775 GOLDEN MILE HWY	MONROEVILLE	PA	15146	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04051	1740 WASHINGTON RD	PITTSBURGH	PA	15241	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04066	1706 THEATRE STREET	LATROBE	PA	15650	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04070	10600 FRANKSTOWN RD.	PITTSBURGH	PA	15235	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04091	7406 CHURCH STREET	SWISSVALE	PA	15218	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04103	355 LINCOLN AVENUE	BELLEVUE	PA	15202	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04115	806 E PITTSBURGH ST	GREENSBURG	PA	15601	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04144	3075 W LIBERTY AVE	PITTSBURGH	PA	15216	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05094	328 COCHRAN RD.	MOUNT LEBANON	PA	15228	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05095	124 ERIE ST.	EDINBORO	PA	16412	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05100	429 SMITHFIELD ST.	PITTSBURGH	PA	15222	10/13/2021	01/01/2022	07/13/2022	07/13/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05101	3870 WASHINGTON RD.	MCMURRAY	PA	15317	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 07612	237 MONROEVILLE AVE	TURTLE CREEK	PA	15145	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10034	611 DUNCAN AVE.	PITTSBURGH	PA	15237	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 10250	1198 SCALP AVE.	JOHNSTOWN	PA	15904	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 10767	4664 BROWNS HILL RD.	PITTSBURGH	PA	15217	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 17448	2661 FREEPORT RD	PITTSBURGH	PA	15238	10/13/2021	01/01/2022		01/01/2022
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY #2589	558 PITTSBURGH STREET	MARS	PA	16046	10/11/2022	01/01/2023		01/01/2023
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 03168	3800 PINE AVE	ERIE	PA	16504	10/11/2022	01/01/2023		01/01/2023
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04256	25 PITTSBURGH ST.	UNIONTOWN	PA	15401	10/11/2022	01/01/2023		01/01/2023
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05099	392 NORTH ST.,	MEADVILLE	PA	16335	10/11/2022	01/01/2023		01/01/2023
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04002	70 W. STEUBEN ST.	PITTSBURGH	PA	15205	10/11/2023	01/01/2024		01/01/2024
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05103	1003 CALIFORNIA AVE	NATRONA HEIGHTS	PA	15065	10/11/2023	01/01/2024		01/01/2024
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 05720	110 SOUTH PLEASANT AVENUE	SOMERSET	PA	15501	10/11/2023	01/01/2024		01/01/2024
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16572	600 CHAUVET DR	PITTSBURGH	PA	15275	10/11/2023	01/01/2024		01/01/2024
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16573	9805 MCKNIGHT RD	PITTSBURGH	PA	15237	10/11/2023	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	07/13/2022	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	07/15/2020	10/01/2020		10/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	07/15/2020	10/01/2020		10/01/2020
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	07/15/2020	10/01/2020		10/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	07/15/2020	10/01/2020		10/01/2020
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #48611	141 PREBLE STREET	PORTLAND	ME	04101	01/16/2024	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	01/16/2024	04/01/2024		04/01/2024
Contract Detail	Rite Aid 6811	701 Delran Pkwy		Delran	NJ	08075	04/10/2025	07/01/2025		04/10/2025
Contract Detail	RITE AID OF OHIO, INC.	RITE AID #3167	304 EAST STATE STREET	ALLIANCE	OH	44601	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #274	1700 MURRAY AVENUE	PITTSBURGH	PA	15217	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #1549	630 MAIN ST.	PORTAGE	PA	15946	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #7843	3700 WALNUT STREET	MCKEESPORT	PA	15132	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #7781	20480 ROUTE 19	CRANBERRY TWP	PA	16066	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #2798	3939 BUTLER STREET	PITTSBURGH	PA	15201	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #268	5504 WALNUT STREET	PITTSBURGH	PA	15232	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #263	685 NORTH MAIN STREET	GREENSBURG	PA	15601	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #6712	100 FORBES AVE STE 100	PITTSBURGH	PA	15222	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #7924	2270 NOBLESTOWN ROAD	PITTSBURGH	PA	15205	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4965	201 GRACE STREET	PITTSBURGH	PA	15211	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4783	5100 LIBRARY ROAD	BETHEL PARK	PA	15102	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #4682	600 WILLIAM MARKS DR	MUNHALL	PA	15120	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RITE AID OF PENNSYLVANIA, LLC	RITE AID #6738	1201 BLAIR ST	HOLLIDAYSBURG	PA	16648	07/17/2023	10/01/2023		10/01/2023
Contract Detail	RX PARTNERS-LTC	500 OLD POND RD STE 406		BRIDGEVILLE	PA	15017	02/25/2020	04/01/2020	04/12/2021	04/12/2021
Contract Detail	SINA DRUG LLC	D/B/A ONCO 360	13410 EASTPOINT CENTRE DR STE 101	LOUISVILLE	KY	40223	10/13/2021	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	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10905	1701 DUNCAN AVENUE	ALLISON PARK	PA	15101	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10934	2336 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10910	4927 HOMEVILLE ROAD	WEST MIFFLIN	PA	15122	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10954	1125 FREEPORT ROAD	PITTSBURGH	PA	15238	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10955	1804 GOLDEN MILE HIGHWAY	PITTSBURGH	PA	15239	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10996	64 NORTH MERCER AVE.	SHARPSVILLE	PA	16150	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10969	10 CLAY PIKE	NORTH HUNTINGDON	PA	15642	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10916	517 BEAVER STREET	SEWICKLEY	PA	15143	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10924	5633 BAUM BOULEVARD	PITTSBURGH	PA	15206	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10938	880 BUTLER STREET	PITTSBURGH	PA	15223	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10947	7345 SALTSBURG ROAD	PENN HILLS	PA	15235	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10939	4411 HOWLEY STREET	PITTSBURGH	PA	15224	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10961	4185 WASHINGTON ROAD	MCMURRAY	PA	15317	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10967	6090 ROUTE 30	GREENSBURG	PA	15601	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10956	1121 BOWER HILL ROAD	PITTSBURGH	PA	15243	07/17/2023	10/01/2023		10/01/2023
Contract Detail	THRIFT DRUG, INC.	RITE AID #10935	331 PENN AVENUE	WILKINSBURG	PA	15221	07/17/2023	10/01/2023	02/01/2025	04/10/2025
Contract Detail	THRIFT DRUG, INC.	RITE AID #10949	5410 KEEPORT DRIVE	PITTSBURGH	PA	15236	07/17/2023	10/01/2023	10/01/2023	10/11/2023
Contract Detail	UPMC PRESBYTERIAN PRESCRIPTION SHOP	UPMC PRESBYTERIAN PRESCRIPTION SHOP	SUITE E-173 200 LOTHROP STREET	PITTSBURGH	PA	15213	02/25/2020	04/01/2020		04/01/2020
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY #10-4643	1500 ECONOMY WAY		BADEN	PA	15005	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1568	1275 NO. HERMITAGE ROAD		HERMITAGE	PA	16148	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1684	72 BEDFORD SQUARE		EVERETT	PA	15537	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1739	30 TRINITY POINT DRIVE		WASHINGTON	PA	15301	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1770	20245 ROUTE 19		CRANBERRY TOWNSHIP	PA	16066	07/13/2022	10/01/2022	10/01/2022	03/30/2023
Contract Detail	WAL-MART PHARMACY 10-1770	20245 ROUTE 19		CRANBERRY TOWNSHIP	PA	16066	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1820	1 HILLTOP PLAZA		KITTANNING	PA	16201	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1883	3942 BRODHEAD RD		MONACA	PA	15061-3028	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-1935	150 TOWN CENTRE DRIVE		JOHNSTOWN	PA	15904	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2008	1566 W MAIN ST EXTENSION		GROVE CITY	PA	16127	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2049	2600 PLANK RD COMMONS		ALTOONA	PA	16602	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2059	2200 GREENGATE CENTER BLVD,		GREENSBURG	PA	15601	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2281	2351 CENTURY DR		WEST MIFFLIN	PA	15122	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2287	2501 WEST STATE ST		NEW CASTLE	PA	16101	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2300	250 SUMMIT PARK DR		PITTSBURGH	PA	15275	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2318	3100 OAKLAND AVE		INDIANA	PA	15701	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2420	100 SARA WAY/ ROSTRAVER SQUARE		BELLE VERNON	PA	15012	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2502	100 COLONY LN		LATROBE	PA	15650	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2540	63 PERKINS ROAD		CLARION	PA	16214	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2588	100 WAL-MART DRIVE		NORTH VERSAILLES	PA	15137	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2597	10 KIMBERLY LANE		CRANBERRY	PA	16319	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2603	300 WAL-MART DRIVE		GIBSONIA	PA	15044	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-2611	2100 SUMMIT RIDGE PLAZA		MT PLEASANT	PA	15666	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3223	#100 CHIPPEWA TOWN CENTRE		BEAVER FALLS	PA	15010	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3228	6700 HOLLYWOOD BLVD		DELMONT	PA	15626	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3738	100 HIGHLANDS MALL		NATRONA HEIGHTS	PA	15065	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-3838	2010 VILLAGE CENTER DRIVE		TARENTUM	PA	15084	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-4348	200 COMMERCE DRIVE		DUNCANSVILLE	PA	16635	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-4501	134 DANIEL KENDALL DR		WEST BROWNSVILLE	PA	15417	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5040	2200 WASHINGTON PIKE		CARNEGIE	PA	15106	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5241	915 MILLS DRIVE		IRWIN	PA	15642	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5379	1450 MORRELL AVENUE		CONNELLSVILLE	PA	15425	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 01034	112 W STEUBEN STREET	CRAFTON	PA	15205	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1701 WILLIAM FLYNN HWY.	GLENSHAW	PA	15116-1747	07/13/2022	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	07/13/2022	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	07/13/2022	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	07/13/2022	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	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09586	1210 WILMINGTON AVENUE	NEW CASTLE	PA	16105-2569	07/13/2022	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	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS # 09675	6201 SALTSBURG ROAD	PITTSBURGH	PA	15235	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	99 JEFFERSON AVE.	WASHINGTON	PA	15301-4434	07/13/2022	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	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	827 MAGILL DRIVE	NORTH HUNTINGDON	PA	15642	07/13/2022	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	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2646 DARLINGTON RD.	BEAVER FALLS	PA	15010-1240	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2055 OLD WASHINGTON PIKE	CARNEGIE	PA	15106	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	1000 LINCOLN PL.	GREENSBURG	PA	15601	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	30 PINE CREEK RD.	WEXFORD	PA	15090-9314	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	7628 PENN AVE.	PITTSBURGH	PA	15221-2114	07/13/2022	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	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	2801 SHARKYS DR.	LATROBE	PA	15650	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	100 CAVASINA DR.	CANONSBURG	PA	15317-1767	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	280 NEW CASTLE RD.	BUTLER	PA	16001-2530	07/13/2022	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	07/13/2022	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	07/13/2022	10/01/2022	11/15/2022	07/17/2023
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	4667 WILLIAM PENN HWY.	MURRYSVILLE	PA	15668	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	234 S MAIN STREET	ZELIENOPLE	PA	16063	07/13/2022	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	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALGREEN EASTERN CO., INC.	DBA: WALGREENS	20260 ROUTE 19	CRANBERRY	PA	16066	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/13/2022	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	07/13/2022	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	07/13/2022	10/01/2022	01/19/2024	01/19/2024
Contract Detail	WALMART PHARMACY 10-4644	7500 UNIVERSITY BOULEVARD		MOON TOWNSHIP	PA	15108-1510	07/17/2023	10/01/2023		10/01/2023
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	07/17/2023	10/01/2023		10/01/2023
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/11/2023	01/01/2024		01/01/2024
Contract Detail	WEST VIRGINIA CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 04167	700 NORTHSIDE DR.	SUMMERSVILLE	WV	26651	10/11/2022	01/01/2023		01/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH390164A	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Mon Pain Clinic HBC (31594) - Pain Center	125 Daugherty Drive	Monroeville	PA	Active
DSH390164AA	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Rehabilitative Service (35205) - PHYSICAL THERAPY	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164AB	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Electrophysiology (30395) - HEART CATHERIZATION	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164AC	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Echocardiology (30390) - ECHO CARDIOLOGY LAB	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164AD	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Ambulatory Surg (32060A) - ASC (NON DISTINCE PART)	3459 Fifth Avenue	Pittsburgh	PA	Active
DSH390164AE	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR-CCS Pittsburgh LTSR (37320) - WPIC RESIDENTIAL TREAT	7165 Churchland Street	Pittsburgh	PA	Active
DSH390164AF	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Radiology West Mifflin (34258) - RADIOLOGY - WEST MIFFLIN	1907 Lebanon Church Rd	Pittsburgh	PA	Active
DSH390164AG	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-MRI (32800A) - MAGNETIC RESONANCE IMAGING	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164AH	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Gastrointestinal Lab (31620) - GASTRO INTESTINAL SVCS	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164AJ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-Merck Child Clinic (37382) - WPIC AYA	11279 Perry Highway	Wexford	PA	Active
DSH390164AK	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - OCD Clinic (37205) - WPIC AFF DISORDERS	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164AL	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - ECT (37395) - WPIC ECT	3811 O'Hara Street	Pittsburgh	PA	Active
DSH390164AM	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Penn Hills Endoscopy Ctr (34256) - CLINIC	1000 Integrity Drive	Pittsburgh	PA	Active
DSH390164AN	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Shea Medical Cntr_Mau (34310) - CLINIC	5200 Centre Avenue	Pittsburgh	PA	Active
DSH390164AP	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-OP Rheumatology (36376) - Kaufmann Clinic	3601 Fifth Avenue	Pittsburgh	PA	Active
DSH390164AQ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-MRI (32880) - MAGNETIC RESONANCE IMAGING	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164AR	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Respiratory Therapy (31600A) - RESPIRATORY THERAPY	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164AS	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MON-Sleep Eval Ctr (30375B) - MONROEVILLE SLEEP CTR	400 Oxford Drive	Monroeville	PA	Active
DSH390164AT	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY - Heart Catheterization (20110) - HEART CATHERIZATION	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164AU	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Sarris HBC (34444) - Falk Clinic	3459 Fifth Avenue	Pittsburgh	PA	Active
DSH390164AV	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Consolidated Outpatient (36660) - CONSOLIDATED O/P TEST	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164AW	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-HCC PET (33032) - HILLMAN CANCER CLINIC	5115 Centre Ave	Pittsburgh	PA	Active
DSH390164AX	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR Adult CTT (37321) - WPIC ICM/RC	5231 Penn Avenue	Pittsburgh	PA	Active
DSH390164AY	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Diabetes and Endocrinology (31585) - OUTPATIENT DIABETES	3601 Fifth Avenue	Pittsburgh	PA	Active
DSH390164AZ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Transplant Patient Svc Ctr (36465) - LABORATORY	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164B	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Interventional Radiology (32905) - RADIOLOGY-DIAGNOSTIC	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164BA	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR-Oxford Outpatient (37085) - WPIC SCHIZOPHRENIA	3501 Forbes Avenue	Pittsburgh	PA	Active
DSH390164BB	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-HCC Radiology Diagnostic (33027) - HILLMAN CANCER CLINIC	5115 Centre Ave	Pittsburgh	PA	Terminated
DSH390164BC	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - Oakland Magee Satellite (37200) - WPIC O/P SATELLITES	300 Halkett Street	Pittsburgh	PA	Active
DSH390164BD	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Anesth Rn Support (32065A) - Anesthesiology	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164BE	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH - Falk Pain Clinic (31598) - Pain Center	3601 Fifth Ave	Pittsburgh	PA	Active
DSH390164BF	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Radiology Diagnostic Sport (32790) - RADIOLOGY-DIAGNOSTIC	3200 South Water Street	Pittsburgh	PA	Active
DSH390164BG	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Bronchoscopy Service (32090A) - RESPIRATORY THERAPY	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164BH	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Cardio-Pulmonary Rehab (30385) - CARDIO- PULMONARY REHAB	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164BJ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-South Hills Surgery Ctr. (34250) - SOUTH HILLS SURG CTR	1300 Oxford Drive	Bethel Park	PA	Active
DSH390164BK	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - Intensive Wraparound (37145) - WPIC AYA	1101 Bingham Street	Pittsburgh	PA	Active
DSH390164BL	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - Eat Disord OP _ Partial (37130) - WPIC BEHAVIORAL MED	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164BM	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - CPCDS IOP (37118) - WPIC D&A	3501 Forbes Avenue	Pittsburgh	PA	Terminated
DSH390164BN	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Ctr - Infectious Diseases (31595) - HIV OUTPATIENT	3601 Fifth Avenue	Pittsburgh	PA	Active
DSH390164BP	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY - Short Stay Unit (20265) - SHORT STAY UNIT	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164BQ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-CRISIS Walk in (37357) - WPIC CACTIS PROGRAM	333 North Braddock Avenue	Pittsburgh	PA	Active
DSH390164BR	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH OR (32090A) - Operating Room	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164BS	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Day of Admission Surgery (32130) - Operating Room	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164BT	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Operating Room (32135) - Operating Room	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164BU	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Post Anesthetic Recovery (32145) - Recovery Room	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164BV	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Radiation Therapy (32895) - RADIOLOGY-THERAPEUTIC	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164BW	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Sth Hills Satellite (34260) - CLINIC	1300 Oxford Drive	Bethel Park	PA	Active
DSH390164BX	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-PUH-Falk Surgery HBC (31591) - Falk Clinic	3601 Fifth Ave	Pittsburgh	PA	Active
DSH390164BY	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-Pine Adolescent IOP (37284) - WPIC PRTL PGM ADULT	11279 Perry Highway	Wexford	PA	Active
DSH390164BZ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Radiology Diagnostic (32785A) - RADIOLOGY-DIAGNOSTIC	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164C	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-Emergency Dept_DEC (33225) - WPIC DEC	3811 O'Hara Street	Pittsburgh	PA	Active
DSH390164CA	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Imaging Monroeville (32780) - MONOE/MURRYSVILLE RAD	600 Oxford Dr	Monroeville	PA	Active
DSH390164CB	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR STEP (37232) - WPIC SCHIZOPHRENIA	3501 Forbes Avenue	Pittsburgh	PA	Active
DSH390164CC	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Benedum Geri Ctr (34190) - BENEDUM GERIATRICS	3459 Fifth Avenue	Pittsburgh	PA	Active
DSH390164CD	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-HCC Phlebotomy (33483) - HILLMAN CANCER CLINIC	5115 Centre Ave	Pittsburgh	PA	Terminated
DSH390164CE	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - Wexford Satellite (37240) - WPIC O/P SATELLITES	11279 Perry Highway	Wexford	PA	Terminated
DSH390164CF	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-Southside IOP Partial (37280) - WPIC PRTL PGM ADULT	1101 Bingham Street	Pittsburgh	PA	Active
DSH390164CG	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-PineAdolesAcutePartial (37282) - WPIC PRTL PGM ADULT	11279 Perry Highway	Wexford	PA	Active
DSH390164CH	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Emergency Dept (33205) - EMERGENCY	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CJ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Surgical Pre-Op (33185) - Operating Room	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164CK	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Radiology Diagnostic (32870) - RADIOLOGY-DIAGNOSTIC	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CL	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-SRS (32890) - RADIOLOGY-THERAPEUTIC	5230 Centre Avenue	Pittsburgh	PA	Terminated
DSH390164CM	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Nuclear Medicine (32885) - RADIOISOTOPE	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CN	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Nuclear Cardiology (30204) - NUCLEAR CARDIOLOGY	5230 Centre Avenue	Pittsburgh	PA	Terminated
DSH390164CP	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-CT (32865) - COMPUTED TOMOGRAPHY (CT)	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CQ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Sleep Eval Ctr (30375A) - MONROEVILLE SLEEP CTR	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164CR	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Electracardiology (30400) - ELECTROCARDIOLOGY	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CS	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Ambulatory Surgery Cen (32115) - ASC (NON DISTINCE PART)	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CT	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Vestibular Lab (36476) - EYE EAR NOSE AND THROAT	203 Lothrop	Pittsburgh	PA	Active
DSH390164CU	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-Child _ Adol Bipolar Svcs (37052) - WPIC AYA	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164CV	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-CPCDS Oxford OP (37120) - WPIC D&A	3501 Forbes Avenue	Pittsburgh	PA	Active
DSH390164CW	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR Transitional Age CTT (37323) - WPIC ICM/RC	5231 Penn Avenue	Pittsburgh	PA	Active
DSH390164CX	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Perfusion Services (32140) - Operating Room	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CY	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Anesthesiology (32120) - Anesthesiology	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164CZ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-CT (32580A) - COMPUTED TOMOGRAPHY (CT)	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164D	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-OP Theiss Health Ctr (34240) - THEISS HEALTH CENTER	373 Burrows Street	Pittsburgh	PA	Terminated
DSH390164DA	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Respiratory Care Service (31655) - RESPIRATORY THERAPY	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164DB	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-EEG EMG (31820A) - ELECTROENCEPHALOGRAPHY	3459 Fifth Avenue	Pittsburgh	PA	Active
DSH390164DC	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Neurodiagnostic Lab Ee (31840) - ELECTROENCEPHALOGRAPHY	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164DD	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-NATP Methadone (37102) - WPIC D&A	225 Penn Avenue	Wilkinsburg	PA	Active
DSH390164DE	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - CPCDS Ambulatory Detox (37119) - WPIC D&A	3501 Forbes Avenue	Pittsburgh	PA	Active
DSH390164DF	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Vascular Clinic HBC (31593) - CLINIC	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164DG	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Senior Care Institute (34540) - CLINIC	5200 Centre Avenue	Pittsburgh	PA	Active
DSH390164DH	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-OP GIM (31590) - Falk Clinic	3601 Fifth Avenue	Pittsburgh	PA	Active
DSH390164DJ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY HCC Rad Nuclear Med (33029) - HILLMAN CANCER CLINIC	5115 Centre Ave	Pittsburgh	PA	Active
DSH390164DK	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-HCC Outpatient Services (33488) - HILLMAN CANCER CLINIC	5115 Centre Ave	Pittsburgh	PA	Active
DSH390164DL	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-Bellefield MH Acute Partl (37121) - WPIC PRTL PGM ADULT	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164DM	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - Child OCD IOP (37206) - WPIC PRTL PGM CHILD	11279 Perry Highway	Wexford	PA	Active
DSH390164DN	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Pacu (32095A) - Recovery Room	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164DP	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Ultrasound (32900) - ULTRASOUND	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164DQ	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Hemodialysis (31625) - ACUTE RENAL DIALYSIS	5230 Centre Avenue	Pittsburgh	PA	Terminated
DSH390164DR	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-Ctr for Children _Families (37050) - WPIC AYA	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164DS	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-Mental Health (37372) - WPIC PSY OUTREACH	333 North Braddock Avenue	Pittsburgh	PA	Terminated
DSH390164DT	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-Medication (37080) - WPIC MEDICAT CLINIC	5231 Penn Avenue	Pittsburgh	PA	Active
DSH390164DU	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-Bellefield OP (37185) - WPIC AFF DISORDERS	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164DV	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - Benedum Geriatrics - (37065)	3459 Fifth Ave.	Pittsburgh	PA	Active
DSH390164DW	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Benign Hematology (31584) - Benign Hematology	3601 Fifth Avenue	Pittsburgh	PA	Active
DSH390164E	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-DERM HBC (31592) - Falk Clinic	3601 Fifth Avenue	Pittsburgh	PA	Active
DSH390164F	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - Family Based Services (37135) - WPIC PSY OUTREACH	1011 Bingham Street	Pittsburgh	PA	Active
DSH390164G	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPICC-CRISIS Overnight (37358) - WPIC CACTIS PROGRAM	333 North Braddock Avenue	Pittsburgh	PA	Active
DSH390164H	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-Center PreSurgical Care (33186) - Operating Room	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164J	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Center Commons Pain HBC (31596) - Pain Center	5750 Centre Ave	Pittsburgh	PA	Active
DSH390164K	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Non-Invasive Vascular (31850) - NON-INV PER VASC LAB	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164L	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Phys Therpy At Puh (35195A) - PHYSICAL THERAPY	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164M	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-Center for Youth at Risk (37064) - WPIC AYA	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164N	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPIC-NATP Buprenorphine (37103) - WPIC D&A	225 Penn Avenue	Wilkinsburg	PA	Terminated
DSH390164P	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPR - J Merck Adult OP (37155) - WPIC SPEC CHILD THERAPY	3501 Forbes Avenue	Pittsburgh	PA	Active
DSH390164Q	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-Bellefield IOP (37063) - WPIC AFF DISORDERS	100 North Bellefield Ave.	Pittsburgh	PA	Active
DSH390164R	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-HCC CT (33026) - HILLMAN CANCER CLINIC	5115 Centre Ave	Pittsburgh	PA	Active
DSH390164S	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-HCC MRI (33031) - HILLMAN CANCER CLINIC	5115 Centre Ave	Pittsburgh	PA	Active
DSH390164T	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPIC-Theiss Program (72705) - WPIC PRTL PGM ADULT	2400 E Carson St	Pittsburgh	PA	Active
DSH390164U	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	WPI-RESPOND Mobile Treatment (37331) - WPIC CACTIS PROGRAM	1101 Bingham Street	Pittsburgh	PA	Active
DSH390164V	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH - Acute Pain (31545A) - Anesthesiology	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164W	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	SHY-Pain Service Perform DAS (32084) - Anesthesiology	5230 Centre Avenue	Pittsburgh	PA	Active
DSH390164X	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	MUH-Ultrasound (32585A) - ULTRASOUND	3459 Fifth Ave	Pittsburgh	PA	Active
DSH390164Y	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH - LSC Imaging (32844) - RADIOLOGY LEMIEUX SC	8000 Cranberry Springs Drive	Cranberry Township	PA	Active
DSH390164Z	Child	DSH	UPMC - PRESBYTERIAN SHADYSIDE	PUH-OP Comp Lung Center (30365) - PULMONARY FUNCTION LAB	3601 Fifth Ave	Pittsburgh	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 8:46:21 AM	9/3/2024 1:32:22 PM	9/3/2024 1:32 PM
Addresses	Shipping Address	Insert	Change Request		SAFECOR HEALTH 4060 BUSINESS PARK DR Columbus, OH 43204	8/9/2024 7:48 AM
Addresses	Shipping Address	Update	Change Request	Shadyside Hospital Campus 5230 Centre Avenue Pittsburgh, PA 15232	UPMC PRESBYTERIAN SHADYSIDE 5230 CENTRE AVE PITTSBURGH, PA 15232	2/13/2024 2:02 PM
Addresses	Shipping Address	Update	Change Request	Western Psych Campus 3811 O'Hara Street Pittsburgh, PA 15213	WESTERN PSYCH INST AND CLINIC 3811 OHARA ST PHARMACY ROOM 15TH FLOOR PITTSBURGH, PA 15213	2/13/2024 2:02 PM
Addresses	Shipping Address	Insert	Change Request		UPMC PRESBYTERIAN SHADYSIDE 200 LOTHROP ST DESOTO AT OHARA STREETS PITTSBURGH, PA 15213	2/13/2024 2:02 PM
Addresses	Shipping Address	Update	Change Request	HC Pharmacy Central 3175 East Carson Street Pittsburgh, PA 15203	HC Pharmacy Central 3175 E Carson Street Pittsburgh, PA 15203	2/9/2024 2:48 PM
Contacts	Primary Contact	Update	Group Change Request	L'Altrelli, Alfred Adam Administrative Director of Pharmacy UPMC Presbyterian 7245549566	Camp, William Zacharie 340B Manager UPMC Presbyterian Shadyside 7406060376	1/25/2024 7:05 AM
Details	Last Recertification Date	Update	Recertification	8/24/2022 11:31:22 AM	8/22/2023 8:46:21 AM	8/22/2023 8:46 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 11:50:28 AM	8/24/2022 11:31:22 AM	8/24/2022 11:31 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1000019040029	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1000019040136	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100001904	8/23/2022 8:50 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1821007881	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306855366	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1053471656	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1144384082	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1750390134	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1518089200	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1164544755	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1790945830	8/23/2022 8:50 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	8/23/2022 8:50 AM
Details	Last Recertification Date	Update	Recertification	8/31/2020 9:32:59 AM	9/10/2021 11:50:28 AM	9/10/2021 11:50 AM
Contacts	Primary Contact	Update	Change Request	Yourich, Bryan Eugene Regional Director of Pharmacy UPMC Presbyterian Shadyside 4126236291	L'Altrelli, Alfred Adam Administrative Director of Pharmacy UPMC Presbyterian 7245549566	4/14/2021 3:13 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10001904 (PA)		11/23/2020 9:42 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1821007881 (PA)		11/23/2020 9:42 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1144384082 (PA)		11/23/2020 9:42 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1053471656 (PA)		11/23/2020 9:42 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1750390134 (PA)		11/23/2020 9:42 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1518089200 (PA)		11/23/2020 9:42 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1164544755 (PA)		11/23/2020 9:42 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 9:32 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 9:32 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 9:32 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 9:32 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 9:32 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 9:32 AM
Details	Last Recertification Date	Update	Recertification		8/31/2020 9:32:59 AM	8/31/2020 9:32 AM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Addresses	Shipping Address	Insert	Change Request		Shadyside Hospital Campus 5230 Centre Avenue Pittsburgh, PA 15232	3/2/2020 4:00 PM
Addresses	Shipping Address	Insert	Change Request		Western Psych Campus 3811 O'Hara Street Pittsburgh, PA 15213	3/2/2020 4:00 PM
Addresses	Shipping Address	Insert	Change Request		Montefiore Campus 3459 Fifth Avenue Pittsburgh, PA 15213	3/2/2020 4:00 PM
Contacts	Signed By	Insert	New Registration		Weiner, Jared CFO, UPMC Presbyterian Shadyside UPMC Aids Center for Treatment 4128647000	2/25/2020 11:50 AM
Details	340B ID	Update	New Registration		DSH390164	2/25/2020 11:50 AM
Dates	Participating Approval Date	Update	New Registration		2/25/2020 11:50:22 AM	2/25/2020 11:50 AM
Details	State	Update	New Registration	Pending	Approved	2/25/2020 11:50 AM
Dates	Signed By Date	Update	New Registration		2/19/2020 2:59:50 PM	2/25/2020 11:50 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/25/2020 11:50 AM
Addresses	Main Address	Insert	New Registration		200 LOTHROP STREET PITTSBURGH, PA 15213	1/8/2020 10:59 AM
Addresses	Billing Address	Insert	New Registration		HC Pharmacy Central 3175 East Carson Street Pittsburgh, PA 15203	1/8/2020 10:59 AM
Addresses	Shipping Address	Insert	New Registration		HC Pharmacy Central 3175 East Carson Street Pittsburgh, PA 15203	1/8/2020 10:59 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/8/2020 10:59 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		10001904	1/8/2020 10:59 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/8/2020 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1821007881	1/8/2020 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1144384082	1/8/2020 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1053471656	1/8/2020 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1750390134	1/8/2020 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1518089200	1/8/2020 10:59 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1164544755	1/8/2020 10:59 AM
Contacts	Authorizing Official	Insert	New Registration		Weiner, Jared CFO, UPMC Presbyterian Shadyside UPMC Aids Center for Treatment 4128647000	1/8/2020 10:59 AM
Contacts	Primary Contact	Insert	New Registration		Yourich, Bryan Eugene Regional Director of Pharmacy UPMC Presbyterian Shadyside 4126236291	1/8/2020 10:59 AM
Details	Last Recertification Date	Insert	New Registration			1/8/2020 10:59 AM
Details	Grant Number	Insert	New Registration			1/8/2020 10:59 AM
Details	340B ID	Insert	New Registration			1/8/2020 10:59 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/8/2020 10:59 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/8/2020 10:59 AM
Details	Medicare Provider Number	Insert	New Registration		390164	1/8/2020 10:59 AM
Details	Entity Name	Insert	New Registration		UPMC - PRESBYTERIAN SHADYSIDE	1/8/2020 10:59 AM
Details	Program Code	Insert	New Registration		DSH	1/8/2020 10:59 AM
Details	Entity Subname	Insert	New Registration			1/8/2020 10:59 AM
Dates	Participating Approval Date	Insert	New Registration			1/8/2020 10:59 AM
Details	State	Insert	New Registration		Pending	1/8/2020 10:59 AM
Dates	Registration Date	Insert	New Registration		1/8/2020 10:59:10 AM	1/8/2020 10:59 AM
Dates	Signed By Date	Insert	New Registration			1/8/2020 10:59 AM
Dates	Start Date	Insert	New Registration			1/8/2020 10:59 AM
Terminations	Termination Comments	Insert	New Registration			1/8/2020 10:59 AM
Terminations	Termination Date	Insert	New Registration			1/8/2020 10:59 AM
Terminations	Termination Effective Date	Insert	New Registration			1/8/2020 10:59 AM
Terminations	Termination Reason	Insert	New Registration			1/8/2020 10:59 AM