Contract Pharmacy Details

AHN PHARMACY #5
DSH390090 West Penn Hospital

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

AHN PHARMACY #5

Pharmacy Address

120 5TH AVE STE 300
PITTSBURGH, PA 15222-3025

Pharmacy Comments

Contract Details

Approval Date

7/17/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Duke Rupert, CEO and President
(412) 578-1176

Contract Pharmacy Representative

Paul Higginbotham, Manager
(878) 332-4121

Signed By Date

7/17/2015