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GIANT EAGLE PHARMACY #0064
DSH390002 UPMC MCKEESPORT
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Covered Entity Details
Entity Name
UPMC MCKEESPORT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390002
Entity Address
1500 FIFTH AVENUE
MCKEESPORT, PA 15132
Medicare Provider Number
390002
Participating Start Date
4/1/2012
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #0064
Pharmacy Address
3812 O'NEIL BLVD
MCKEESPORT, PA 15132
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
Laurene Timmons, CFO
(412) 664-6781
Contract Pharmacy Representative
GIANT EAGLE
Mike Bianco, President & CEO
(412) 967-3718
Signed By Date
7/10/2020
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