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CHARTWELL PENNSYLVANIA
DSH390073 ALTOONA REGIONAL HEALTH SYSTEM
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Covered Entity Details
Entity Name
ALTOONA REGIONAL HEALTH SYSTEM
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390073
Entity Address
620 HOWARD AVENUE
ALTOONA, PA 16601-4889
Medicare Provider Number
390073
Participating Start Date
10/1/2018
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
CHARTWELL PENNSYLVANIA
Pharmacy Address
1001 OAKDALE RD
OAKDALE, PA 15071-1502
Pharmacy Comments
Contract Details
Approval Date
8/30/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mario Edward Wilfong, CFO
(412) 692-8201
Contract Pharmacy Representative
UPMC Pinnacle
Kathie Patrick, Manager
(412) 818-7665
Signed By Date
7/17/2018
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