Contract Pharmacy Details

GIANT EAGLE PHARMACY #0019
DSH390028 UPMC MERCY

Covered Entity Details

Entity Name

UPMC MERCY

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH390028

Entity Address

1400 LOCUST STREET
PITTSBURGH, PA 15219

Medicare Provider Number

390028

Participating Start Date

9/2/2008

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

GIANT EAGLE PHARMACY #0019

Pharmacy Address

1233 BROAD ST
JOHNSTOWN, PA 15906

Pharmacy Comments

Contract Details

Approval Date

7/10/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/9/2021
Agreement registered in error

Contacts

Covered Entity Signing Official

Richard Bugni, Director of Finance
(412) 802-8231

Contract Pharmacy Representative

GIANT EAGLE
Mike Bianco, President & CEO
(412) 967-3718

Signed By Date

7/10/2020