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GIANT EAGLE PHARMACY #8991
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
GIANT EAGLE PHARMACY #8991
Pharmacy Address
2500 LOVI RD
FREEDOM, PA 15042
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Johnson, President & CEO
(412) 578-1176
Contract Pharmacy Representative
340B Direct
Ashley Tomaskovich, Vice President of Networks and Analytics
(863) 967-2202
Signed By Date
7/15/2021
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