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DSH390073L ALTOONA REGIONAL HEALTH SYSTEM (Active)
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Main Details
Name
ALTOONA REGIONAL HEALTH SYSTEM
Subdivision Name
University Pittsburgh Medical Center WILLIAMSBURG FAMILY PRACTICE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390073L
Medicare Provider Number
390073
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/12/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/30/2018
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
UPMC Altoona
Monica J Klatt, Chief Financial Officer
(814) 889-2223
Primary Contact
UPMC
Stephen Bedell, 340B Manager
(703) 232-5693
Addresses
Street Address
306 PLUM ST
WILLIAMSBURG FAMILY PRACTICE
WILLIAMSBURG, PA 16693-1116
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
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Participating from effective date (7/1/2017) until terminated effective date (1/1/2018) reinstatement date effective date (10/01/2018)
08/03/2018
June 2025
June 2025
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