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GIANT EAGLE PHARMACY #0071
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
GIANT EAGLE PHARMACY #0071
Pharmacy Address
181 SOPHIRA LANE
ALTOONA, PA 16602
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
1/26/2021
CE terminated due to audit finding
Contacts
Covered Entity Signing Official
Monica J Klatt, Chief Financial Officer
(814) 889-2223
Contract Pharmacy Representative
GIANT EAGLE
Mike Bianco, President & CEO
(412) 967-3718
Signed By Date
7/10/2020
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