Covered Entity Details

PED393302-40 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (Active) - information as of 6/9/2025 11:01:36 PM

Main Details

Name

UPMC CHILDREN'S HOSPITAL OF PITTSBURGH

Subdivision Name

CHP-Pulmonology North - (31315)

Type

Children's Hospital

Rural

340B ID

PED393302-40

Medicare Provider Number

393302

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/10/2023

Participating Start Date

1/1/2024

Participating Approval Date

11/27/2023

Last Recertification Date

9/6/2024

Contacts

Authorizing Official

UPMC
Mario Edward Wilfong, CFO
(412) 692-8201

Primary Contact

UPMC
Amanda Pell, Manager, 340B Program
(814) 771-8354

Addresses

Street Address

2599 Wexford-Bayne Road
Wexford, PA 15143

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	1007347990017,1007347990012,1007347990004,1007347990059,1007347990089,1007347990060,1007347990069	1164426896,1053476556,1083851968,1619313350,1194889485

Shipping Addresses

Shipping Address 1

HC PHARMACY CENTRAL - PROCUREMENT
3175 E. CARSON ST
Pittsburgh, PA 15203

Shipping Address 2

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
PED393302-01	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	Outpatient Surgery	2599 WEXFORD BAYNE ROAD	SEWICKLEY	PA	Terminated
PED393302-02	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	SOUTH SATELLITE	205 Millers Run Road	BRIDGEVILLE	PA	Terminated
PED393302-03	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	SAME DAY SURGERY-MAIN HOSPITAL (SPU)	4401 PENN AVENUE	PITTSBURGH	PA	Terminated
PED393302-04	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	EAST SATELLITE	4055 MONROEVILLE BLVD.	MONROEVILLE	PA	Terminated
PED393302-05	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	RENAL CLINIC	4401 PENN AVENUE	PITTSBURGH	PA	Terminated
PED393302-06	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Communication Disorders	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-07	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Phlebotomy Services	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-08	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Radiology Diagnostic	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-09	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Occupational Therapy	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-10	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Physical Therapy	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-11	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Pulmonary Function	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-12	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Electroencephalography	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-13	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/EKG / ECHO	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-14	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	South Satellite/Audiology	205 Millers Run Road	Bridgeville	PA	Terminated
PED393302-15	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Electroencephalography	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-16	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Phlebotomy Services	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-17	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Pulmonary Function	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-18	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/EKG / ECHO	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-19	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Occupational Therapy	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-20	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Physical Therapy	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-21	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Radiology Diagnostic	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-22	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Communication Disorders	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-23	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	East Satellite/Audiology	4055 Monroeville Boulevard	Monroeville	PA	Terminated
PED393302-24	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Ronald McDonald Care Mobile	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-25	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Phlebotomy Services	11279 Perry Highway	Wexford	PA	Terminated
PED393302-26	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Electromyography	11279 Perry Highway	Wexford	PA	Terminated
PED393302-27	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Electroencephalography	11279 Perry Highway	Wexford	PA	Terminated
PED393302-28	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Child & Family Counseling	11279 Perry Highway	Wexford	PA	Terminated
PED393302-29	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Communication Disorders	11279 Perry Highway	Wexford	PA	Terminated
PED393302-30	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Occupational Therapy	11279 Perry Highway	Wexford	PA	Terminated
PED393302-31	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Sleep Study Center	2619 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-32	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Pulmonary Function	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-33	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Phlebotomy Services	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-34	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/EKG / ECHO	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-35	Child	PED	CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC	North Satellite/MRI	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-36	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Radiology Diagnostic	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-37	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Audiology	2559 Wexford-Bayne Road	Sewickley	PA	Terminated
PED393302-38	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Surgery Center	2599 Wexford-Bayne Road	Sewickley	PA	Active
PED393302-39	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	North Satellite/Physical Therapy	11279 Perry Highway	Wexford	PA	Terminated
PED393302-40	Child	PED	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	CHP-Pulmonology North - (31315)	2599 Wexford-Bayne Road	Wexford	PA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Billing Address	Update	Group Change Request	HC PHARMACY CENTRAL - PROCUREMENT 3175 E. CARSON ST Pittsburgh, PA 15203	UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain PO Box 2058 Portland, OR 97208	5/15/2025 11:13 AM
Addresses	Shipping Address	Insert	Group Change Request		UPMC Presbyterian Shadyside DBA UPMC Pharmacy Supply Chain 3175 E Carson St Pittsburgh, PA 15203	5/15/2025 11:13 AM
Details	Last Recertification Date	Update	Recertification		9/6/2024 11:11:03 AM	9/6/2024 11:11 AM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Contacts	Signed By	Insert	New Registration		Wilfong, Mario Edward CFO UPMC 4126928201	11/27/2023 4:42 PM
Details	340B ID	Update	New Registration		PED393302-40	11/27/2023 4:42 PM
Details	Entity Name	Update	New Registration	UPMC CHILDRENS HOSPITAL OF PGH	UPMC CHILDREN'S HOSPITAL OF PITTSBURGH	11/27/2023 4:42 PM
Details	Entity Subname	Update	New Registration	CHP-Pulmonology North	CHP-Pulmonology North - (31315)	11/27/2023 4:42 PM
Dates	Participating Approval Date	Update	New Registration		11/27/2023 4:42:46 PM	11/27/2023 4:42 PM
Details	State	Update	New Registration	Pending	Approved	11/27/2023 4:42 PM
Dates	Signed By Date	Update	New Registration		11/17/2023 12:39:51 PM	11/27/2023 4:42 PM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	11/27/2023 4:42 PM
Addresses	Main Address	Insert	New Registration		2599 Wexford-Bayne Road Wexford, PA 15143	10/10/2023 11:55 AM
Addresses	Billing Address	Insert	New Registration		HC PHARMACY CENTRAL - PROCUREMENT 3175 E. CARSON ST Pittsburgh, PA 15203	10/10/2023 11:55 AM
Addresses	Shipping Address	Insert	New Registration		HC PHARMACY CENTRAL - PROCUREMENT 3175 E. CARSON ST Pittsburgh, PA 15203	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007347990017	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007347990012	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007347990004	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007347990059	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007347990089	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007347990060	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007347990069	10/10/2023 11:55 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1164426896	10/10/2023 11:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1053476556	10/10/2023 11:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1083851968	10/10/2023 11:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1619313350	10/10/2023 11:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1194889485	10/10/2023 11:55 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/10/2023 11:55 AM
Contacts	Authorizing Official	Insert	New Registration		Wilfong, Mario Edward CFO UPMC 4126928201	10/10/2023 11:55 AM
Contacts	Primary Contact	Insert	New Registration		Pell, Amanda Manager, 340B Program UPMC 8147718354	10/10/2023 11:55 AM
Details	Assistance Received From Date	Insert	New Registration			10/10/2023 11:55 AM
Details	Assistance Received To Date	Insert	New Registration			10/10/2023 11:55 AM
Details	Last Recertification Date	Insert	New Registration			10/10/2023 11:55 AM
Details	Grant Number	Insert	New Registration			10/10/2023 11:55 AM
Details	340B ID	Insert	New Registration			10/10/2023 11:55 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/10/2023 11:55 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/10/2023 11:55 AM
Details	Medicare Provider Number	Insert	New Registration		393302	10/10/2023 11:55 AM
Details	Entity Name	Insert	New Registration		UPMC CHILDRENS HOSPITAL OF PGH	10/10/2023 11:55 AM
Details	NOFO Number	Insert	New Registration			10/10/2023 11:55 AM
Details	Program Code	Insert	New Registration		PED	10/10/2023 11:55 AM
Details	Entity Subname	Insert	New Registration		CHP-Pulmonology North	10/10/2023 11:55 AM
Dates	Participating Approval Date	Insert	New Registration			10/10/2023 11:55 AM
Details	State	Insert	New Registration		Pending	10/10/2023 11:55 AM
Dates	Registration Date	Insert	New Registration		10/10/2023 11:55:56 AM	10/10/2023 11:55 AM
Dates	Signed By Date	Insert	New Registration			10/10/2023 11:55 AM
Dates	Start Date	Insert	New Registration			10/10/2023 11:55 AM
Terminations	Termination Comments	Insert	New Registration			10/10/2023 11:55 AM
Terminations	Termination Date	Insert	New Registration			10/10/2023 11:55 AM
Terminations	Termination Effective Date	Insert	New Registration			10/10/2023 11:55 AM
Terminations	Termination Reason	Insert	New Registration			10/10/2023 11:55 AM