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ASTI'S SOUTH HILLS PHARMACY
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
ASTI'S SOUTH HILLS PHARMACY
Pharmacy Address
250 MOUNT LEBANON BLVD
PITTSBURGH, PA 15234-1252
Pharmacy Comments
Contract Details
Approval Date
7/18/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ron Andro, President and CEO
(412) 578-1176
Contract Pharmacy Representative
Asti's South Hills Pharmacy
Christopher Antypas, President & Chief Operating Officer
(412) 561-2347
Signed By Date
7/18/2017
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