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GIANT EAGLE PHARMACY #0040
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 #0040
Pharmacy Address
5550 CENTRE AVE
PITTSBURGH, PA 15232
Pharmacy Comments
Contract Details
Approval Date
4/26/2012
Contract Begin Date
4/26/2012
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
Duke Rupert, CEO and President
(412) 578-1176
Contract Pharmacy Representative
Brett L. Merrell, Senior Vice President, Health & Wellness
(412) 968-1550
Signed By Date
4/17/2012
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