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UPMC PRESBYTERIAN PRESCRIPTION SHOP
DSH390164 UPMC - PRESBYTERIAN SHADYSIDE
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Covered Entity Details
Entity Name
UPMC - PRESBYTERIAN SHADYSIDE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390164
Entity Address
200 LOTHROP STREET
PITTSBURGH, PA 15213
Medicare Provider Number
390164
Participating Start Date
4/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
UPMC PRESBYTERIAN PRESCRIPTION SHOP
Pharmacy Address
UPMC PRESBYTERIAN PRESCRIPTION SHOP
SUITE E-173
200 LOTHROP STREET
PITTSBURGH, PA 15213
Pharmacy Comments
Contract Details
Approval Date
2/25/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Weiner, CFO, UPMC Presbyterian Shadyside
(412) 864-7000
Contract Pharmacy Representative
UPMC Pinnacle
Kathie Patrick, Manager
(412) 818-7665
Signed By Date
1/13/2020
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