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CYSTIC FIBROSIS SERVICES
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
CYSTIC FIBROSIS SERVICES
Pharmacy Address
CYSTIC FIBROSIS SERVICES, INC
10530 JOHN W ELLIOTT DR, STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
1/18/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/21/2018
Ownership change
Contacts
Covered Entity Signing Official
Ron Andro, President and CEO
(412) 578-1176
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/18/2016
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