Covered Entity Details

DSH390063C UPMC HAMOT (Active) - information as of 5/24/2025 12:35:23 AM

Main Details

Name

UPMC HAMOT

Subdivision Name

UPMC HAMOT - Hamot NICU Clinic (22001)

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390063C

Medicare Provider Number

390063

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/15/2020

Participating Start Date

4/1/2020

Participating Approval Date

2/26/2020

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

118 EAST 2ND STREET
MAGEE-WOMENS, UPMC HAMOT
ERIE, PA 16507-1502

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

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
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 East Carson Street 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	Delete	Group Change Request	HC Pharmacy Central- Procurement 3175 East Carson Street Pittsburgh, PA 15203		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
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 12:52:04 PM	9/6/2024 1:14:24 PM	9/6/2024 1:14 PM
Details	Entity Subname	Update	Change Request	UPMC HAMOT - Hamot NICU Clinic	UPMC HAMOT - Hamot NICU Clinic (22001)	2/5/2024 2:43 PM
Details	Last Recertification Date	Update	Recertification	8/29/2022 1:45:48 PM	8/22/2023 12:52:04 PM	8/22/2023 12:52 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 12:40:28 PM	8/29/2022 1:45:48 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 1:22:56 PM	9/13/2021 12:40:28 PM	9/13/2021 12:40 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 12:40 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1007286570033 (PA)		11/25/2020 9:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1487647590 (PA)		11/25/2020 9:04 AM
Medicaid Billing	NPI: State	Update	Recertification		PA	9/1/2020 1:22 PM
Details	Last Recertification Date	Update	Recertification		9/1/2020 1:22:56 PM	9/1/2020 1:22 PM
Details	State	Update		Approved	Active	4/1/2020 12:05 AM
Contacts	Signed By	Insert	New Registration		Dinger, Brad N CFO UPMC Hamot 8148773739	2/26/2020 10:34 AM
Details	340B ID	Update	New Registration		DSH390063C	2/26/2020 10:34 AM
Details	Entity Subname	Update	New Registration	UPMC HAMOT	UPMC HAMOT - Hamot NICU Clinic	2/26/2020 10:34 AM
Dates	Participating Approval Date	Update	New Registration		2/26/2020 10:34:43 AM	2/26/2020 10:34 AM
Details	State	Update	New Registration	Pending	Approved	2/26/2020 10:34 AM
Dates	Signed By Date	Update	New Registration		1/15/2020 6:31:04 PM	2/26/2020 10:34 AM
Dates	Start Date	Update	New Registration		4/1/2020 12:00:00 AM	2/26/2020 10:34 AM
Addresses	Main Address	Insert	New Registration		118 EAST 2ND STREET MAGEE-WOMENS, UPMC HAMOT ERIE, PA 16507-1502	1/15/2020 6:31 PM
Addresses	Billing Address	Insert	New Registration		HC Pharmacy Central- Procurement 3175 East Carson Street Pittsburgh, PA 15203	1/15/2020 6:31 PM
Addresses	Shipping Address	Insert	New Registration		HC Pharmacy Central- Procurement 3175 East Carson Street Pittsburgh, PA 15203	1/15/2020 6:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/15/2020 6:31 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007286570033	1/15/2020 6:31 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	1/15/2020 6:31 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1487647590	1/15/2020 6:31 PM
Contacts	Primary Contact	Insert	New Registration		Belavic, Jennifer Director of Pharmacy UPMC Hamot 8148772710	1/15/2020 6:31 PM
Contacts	Authorizing Official	Insert	New Registration		Dinger, Brad N CFO UPMC Hamot 8148773739	1/15/2020 6:31 PM
Details	Last Recertification Date	Insert	New Registration			1/15/2020 6:31 PM
Details	Grant Number	Insert	New Registration			1/15/2020 6:31 PM
Details	340B ID	Insert	New Registration			1/15/2020 6:31 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/15/2020 6:31 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/15/2020 6:31 PM
Details	Medicare Provider Number	Insert	New Registration		390063	1/15/2020 6:31 PM
Details	Entity Name	Insert	New Registration		UPMC HAMOT	1/15/2020 6:31 PM
Details	Program Code	Insert	New Registration		DSH	1/15/2020 6:31 PM
Details	Entity Subname	Insert	New Registration		UPMC HAMOT	1/15/2020 6:31 PM
Dates	Participating Approval Date	Insert	New Registration			1/15/2020 6:31 PM
Details	State	Insert	New Registration		Pending	1/15/2020 6:31 PM
Dates	Registration Date	Insert	New Registration		1/15/2020 6:31:01 PM	1/15/2020 6:31 PM
Dates	Signed By Date	Insert	New Registration			1/15/2020 6:31 PM
Dates	Start Date	Insert	New Registration			1/15/2020 6:31 PM
Terminations	Termination Comments	Insert	New Registration			1/15/2020 6:31 PM
Terminations	Termination Date	Insert	New Registration			1/15/2020 6:31 PM
Terminations	Termination Effective Date	Insert	New Registration			1/15/2020 6:31 PM
Terminations	Termination Reason	Insert	New Registration			1/15/2020 6:31 PM