Covered Entity Details

DSH390039A SOMERSET HOSPITAL (Active) - information as of 5/6/2025 12:00:02 AM

Main Details

Name

SOMERSET HOSPITAL

Subdivision Name

SOM00 - Occupational Medicine - Occupational Health

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH390039A

Medicare Provider Number

390039

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/12/2022

Participating Start Date

7/1/2022

Participating Approval Date

4/12/2022

Last Recertification Date

9/4/2024

Contacts

Authorizing Official

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

Primary Contact

UPMC Somerset
Gwen Greathouse, Pharmacy Director
(814) 443-5116

Addresses

Street Address

126 East Church Street
Somerset, PA 15501

Billing Address
Same as Street Address

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	1002086660009,1002086660043,1002086660022,1002086660028,1002086660042,1002086660015	1912900168,1073692679,1558381988,1053424978

Shipping Addresses

Shipping Address 1

Somerset Hospital Pharmacy
225 South Center Avenue
Suite 1049
Somerset, PA 15501

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
DSH390039A	Child	DSH	SOMERSET HOSPITAL	SOM00 - Occupational Medicine - Occupational Health	126 East Church Street	Somerset	PA	Active
DSH390039B	Child	DSH	SOMERSET HOSPITAL	SOM00 - Oncology - (48656)	314 S. Kimberly Ave	Somerset	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/22/2023 1:39:58 PM	9/4/2024 2:21:42 PM	9/4/2024 2:21 PM
Details	Last Recertification Date	Update	Recertification	8/31/2022 1:12:07 PM	8/22/2023 1:39:58 PM	8/22/2023 1:39 PM
Details	Last Recertification Date	Update	Recertification		8/31/2022 1:12:07 PM	8/31/2022 1:12 PM
Details	State	Update		Approved	Active	7/1/2022 12:01 AM
Contacts	Signed By	Insert	New Registration		Klatt, Monica J Chief Financial Officer UPMC Altoona 8148892223	4/12/2022 3:51 PM
Details	340B ID	Update	New Registration		DSH390039A	4/12/2022 3:51 PM
Details	Entity Subname	Update	New Registration	SOM00 - Occupational Medicine	SOM00 - Occupational Medicine - Occupational Health	4/12/2022 3:51 PM
Dates	Participating Approval Date	Update	New Registration		4/12/2022 3:51:30 PM	4/12/2022 3:51 PM
Details	State	Update	New Registration	Pending	Approved	4/12/2022 3:51 PM
Dates	Signed By Date	Update	New Registration		4/12/2022 12:14:24 PM	4/12/2022 3:51 PM
Dates	Start Date	Update	New Registration		7/1/2022 12:00:00 AM	4/12/2022 3:51 PM
Addresses	Main Address	Insert	New Registration		126 East Church Street Somerset, PA 15501	4/12/2022 12:14 PM
Addresses	Shipping Address	Insert	New Registration		Somerset Hospital Pharmacy 225 South Center Avenue Suite 1049 Somerset, PA 15501	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1002086660009	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1002086660043	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1002086660022	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1002086660028	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1002086660042	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1002086660015	4/12/2022 12:14 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1912900168	4/12/2022 12:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1073692679	4/12/2022 12:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1558381988	4/12/2022 12:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1053424978	4/12/2022 12:14 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	4/12/2022 12:14 PM
Contacts	Authorizing Official	Insert	New Registration		Klatt, Monica J Chief Financial Officer UPMC Altoona 8148892223	4/12/2022 12:14 PM
Contacts	Primary Contact	Insert	New Registration		Greathouse, Gwen Pharmacy Director UPMC Somerset 8144435116	4/12/2022 12:14 PM
Details	Assistance Received From Date	Insert	New Registration			4/12/2022 12:14 PM
Details	Assistance Received To Date	Insert	New Registration			4/12/2022 12:14 PM
Details	Last Recertification Date	Insert	New Registration			4/12/2022 12:14 PM
Details	Grant Number	Insert	New Registration			4/12/2022 12:14 PM
Details	340B ID	Insert	New Registration			4/12/2022 12:14 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/12/2022 12:14 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/12/2022 12:14 PM
Details	Medicare Provider Number	Insert	New Registration		390039	4/12/2022 12:14 PM
Details	Entity Name	Insert	New Registration		SOMERSET HOSPITAL	4/12/2022 12:14 PM
Details	NOFO Number	Insert	New Registration			4/12/2022 12:14 PM
Details	Program Code	Insert	New Registration		DSH	4/12/2022 12:14 PM
Details	Entity Subname	Insert	New Registration		SOM00 - Occupational Medicine	4/12/2022 12:14 PM
Dates	Participating Approval Date	Insert	New Registration			4/12/2022 12:14 PM
Details	State	Insert	New Registration		Pending	4/12/2022 12:14 PM
Dates	Registration Date	Insert	New Registration		4/12/2022 12:14:20 PM	4/12/2022 12:14 PM
Dates	Signed By Date	Insert	New Registration			4/12/2022 12:14 PM
Dates	Start Date	Insert	New Registration			4/12/2022 12:14 PM
Terminations	Termination Comments	Insert	New Registration			4/12/2022 12:14 PM
Terminations	Termination Date	Insert	New Registration			4/12/2022 12:14 PM
Terminations	Termination Effective Date	Insert	New Registration			4/12/2022 12:14 PM
Terminations	Termination Reason	Insert	New Registration			4/12/2022 12:14 PM