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PED393302-12 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH (Terminated)
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Main Details
Name
UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Subdivision Name
South Satellite/Electroencephalography
Type
Children's Hospital
Rural
No
340B ID
PED393302-12
Medicare Provider Number
393302
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/28/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/8/2014
Last Recertification Date
9/1/2020
Termination Date
Termination Reason
10/1/2021
Hospital Outpatient facility no longer eligible
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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