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PENNSYLVANIA CVS PHARMACY, L.L.C.
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
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02348
3422 FORBES AVENUE
PITTSBURGH, PA 15213
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Weiner, CFO, UPMC Presbyterian Shadyside
(412) 864-7000
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2021
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