Covered Entity Details

DSH390164BG UPMC - PRESBYTERIAN SHADYSIDE (Active) - information as of 4/29/2025 1:40:42 AM

Main Details

Name

UPMC - PRESBYTERIAN SHADYSIDE

Subdivision Name

MUH-Bronchoscopy Service (32090A) - RESPIRATORY THERAPY

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390164BG

Medicare Provider Number

390164

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/8/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/26/2020

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

3459 Fifth Ave
Pittsburgh
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 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
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	8/21/2023 5:18:38 PM	9/3/2024 2:11:38 PM	9/3/2024 2:11 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 12:02:08 PM	8/21/2023 5:18:38 PM	8/21/2023 5:18 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1000019040029	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1000019040136	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		100001904	2/2/2023 8:09 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1821007881	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1306855366	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1053471656	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1144384082	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1750390134	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1518089200	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1164544755	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1790945830	2/2/2023 8:09 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		PA	2/2/2023 8:09 AM
Details	Last Recertification Date	Update	Recertification	9/10/2021 12:36:14 PM	8/24/2022 12:02:08 PM	8/24/2022 12:02 PM
Details	Last Recertification Date	Update	Recertification	8/31/2020 10:21:59 AM	9/10/2021 12:36:14 PM	9/10/2021 12:36 PM
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 3:02 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	10001904 (PA)		11/23/2020 10:03 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1821007881 (PA)		11/23/2020 10:03 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1144384082 (PA)		11/23/2020 10:03 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1053471656 (PA)		11/23/2020 10:03 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1750390134 (PA)		11/23/2020 10:03 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1518089200 (PA)		11/23/2020 10:03 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1164544755 (PA)		11/23/2020 10:03 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 10:21 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 10:21 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 10:21 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 10:21 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 10:21 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	8/31/2020 10:21 AM
Details	Last Recertification Date	Update	Recertification		8/31/2020 10:21:59 AM	8/31/2020 10:21 AM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Weiner, Jared CFO, UPMC Presbyterian Shadyside UPMC Aids Center for Treatment 4128647000	2/26/2020 2:30 PM
Details	340B ID	Update	New Registration		DSH390164BG	2/26/2020 2:30 PM
Details	Entity Subname	Update	New Registration	MUH-Bronchoscopy Service (32090A)	MUH-Bronchoscopy Service (32090A) - RESPIRATORY THERAPY	2/26/2020 2:30 PM
Dates	Participating Approval Date	Update	New Registration		2/26/2020 2:30:45 PM	2/26/2020 2:30 PM
Details	State	Update	New Registration	Pending	Approved	2/26/2020 2:30 PM
Dates	Signed By Date	Update	New Registration		2/17/2020 11:56:48 AM	2/26/2020 2:30 PM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/26/2020 2:30 PM
Addresses	Main Address	Insert	New Registration		3459 Fifth Ave Pittsburgh Pittsburgh, PA 15213	1/8/2020 4:11 PM
Addresses	Billing Address	Insert	New Registration		HC Pharmacy Central 3175 East Carson Street Pittsburgh, PA 15203	1/8/2020 4:11 PM
Addresses	Shipping Address	Insert	New Registration		HC Pharmacy Central 3175 East Carson Street Pittsburgh, PA 15203	1/8/2020 4:11 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/8/2020 4:11 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		10001904	1/8/2020 4:11 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/8/2020 4:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821007881	1/8/2020 4:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1144384082	1/8/2020 4:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1053471656	1/8/2020 4:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1750390134	1/8/2020 4:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1518089200	1/8/2020 4:11 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1164544755	1/8/2020 4:11 PM
Contacts	Authorizing Official	Insert	New Registration		Weiner, Jared CFO, UPMC Presbyterian Shadyside UPMC Aids Center for Treatment 4128647000	1/8/2020 4:11 PM
Contacts	Primary Contact	Insert	New Registration		Yourich, Bryan Eugene Regional Director of Pharmacy UPMC Presbyterian Shadyside 4126236291	1/8/2020 4:11 PM
Details	Last Recertification Date	Insert	New Registration			1/8/2020 4:11 PM
Details	Grant Number	Insert	New Registration			1/8/2020 4:11 PM
Details	340B ID	Insert	New Registration			1/8/2020 4:11 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/8/2020 4:11 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/8/2020 4:11 PM
Details	Medicare Provider Number	Insert	New Registration		390164	1/8/2020 4:11 PM
Details	Entity Name	Insert	New Registration		UPMC - PRESBYTERIAN SHADYSIDE	1/8/2020 4:11 PM
Details	Program Code	Insert	New Registration		DSH	1/8/2020 4:11 PM
Details	Entity Subname	Insert	New Registration		MUH-Bronchoscopy Service (32090A)	1/8/2020 4:11 PM
Dates	Participating Approval Date	Insert	New Registration			1/8/2020 4:11 PM
Details	State	Insert	New Registration		Pending	1/8/2020 4:11 PM
Dates	Registration Date	Insert	New Registration		1/8/2020 4:11:32 PM	1/8/2020 4:11 PM
Dates	Signed By Date	Insert	New Registration			1/8/2020 4:11 PM
Dates	Start Date	Insert	New Registration			1/8/2020 4:11 PM
Terminations	Termination Comments	Insert	New Registration			1/8/2020 4:11 PM
Terminations	Termination Date	Insert	New Registration			1/8/2020 4:11 PM
Terminations	Termination Effective Date	Insert	New Registration			1/8/2020 4:11 PM
Terminations	Termination Reason	Insert	New Registration			1/8/2020 4:11 PM