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PED393302-02 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (Terminated)
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Main Details
Name
UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Subdivision Name
SOUTH SATELLITE
Type
Children's Hospital
Rural
No
340B ID
PED393302-02
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
9/1/2020
Termination Date
Termination Reason
10/1/2021
Other
Contacts
Authorizing Official
UPMC
Mario Edward Wilfong, CFO
(412) 692-8201
Primary Contact
Children's Hospital of Pittsburgh of UPMC
Anthony Patterson, Director of Pharmacy
(412) 692-6242
Addresses
Street Address
205 Millers Run Road
BRIDGEVILLE, PA 15017
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-OPA NOTIFIED ON 1/27/2010-UPDATED SHIPPING ADDRESS (WAS CHILDREN'S HOSPITAL OF PITTSBURGH OF UPMC,4401 PENN AVENUE,15224)
04/30/2010
April 2025
April 2025
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