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UPMC CHILDRENS HOSPITAL OF PITTSBURGH
DSH390028 UPMC MERCY
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Covered Entity Details
Entity Name
UPMC MERCY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390028
Entity Address
1400 LOCUST STREET
PITTSBURGH, PA 15219
Medicare Provider Number
390028
Participating Start Date
9/2/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
UPMC CHILDRENS HOSPITAL OF PITTSBURGH
Pharmacy Address
4401 PENN AVE
PITTSBURGH, PA 15224-1334
Pharmacy Comments
Contract Details
Approval Date
7/12/2011
Contract Begin Date
7/15/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/14/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/16/2011
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