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LEECHBURG PHRMY-LONG TERM CARE
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
LEECHBURG PHRMY-LONG TERM CARE
Pharmacy Address
111 2ND ST
LEECHBURG, PA 15656-1326
Pharmacy Comments
Contract Details
Approval Date
9/20/2012
Contract Begin Date
9/20/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Duke Rupert, CEO and President
(412) 578-1176
Contract Pharmacy Representative
Don Williams, Vice President
(724) 845-7677
Signed By Date
8/31/2012
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