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PED393302-01 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (Terminated)
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Main Details
Name
UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Subdivision Name
Outpatient Surgery
Type
Children's Hospital
Rural
No
340B ID
PED393302-01
Medicare Provider Number
393302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
12/8/2009
Participating Start Date
1/1/2010
Participating Approval Date
12/15/2009
Last Recertification Date
8/24/2023
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
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
SEWICKLEY, PA 15143
Billing Address
HC PHARMACY CENTRAL – PROCUREMENT
3175 E. CARSON ST
PITTSBURGH, PA 15203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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4/30/2010- UPDATED SHIPPING ADDRESS (WAS4401 PENN AVENUE,15224)
04/30/2010
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