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JEFFERSON REGIONAL MEDICAL CENTER
DSH390090 West Penn Hospital
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Covered Entity Details
Entity Name
West Penn Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390090
Entity Address
4800 FRIENDSHIP AVE
PITTSBURGH, PA 15224-1722
Medicare Provider Number
390090
Participating Start Date
10/20/2005
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
JEFFERSON REGIONAL MEDICAL CENTER
Pharmacy Address
565 COAL VALLEY ROAD
JEFFERSON HILLS, PA 15025
Pharmacy Comments
Contract Details
Approval Date
1/11/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronald J Andro, President & CEO
(412) 578-1176
Contract Pharmacy Representative
Allegheny Health Network
Paul Higginbotham, Director Retail Pharmacy
(614) 743-7945
Signed By Date
1/11/2019
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