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GIANT EAGLE PHARMACY #0069
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
GIANT EAGLE PHARMACY #0069
Pharmacy Address
9001 FRANKSTOWN RD
PITTSBURGH, PA 15235
Pharmacy Comments
Contract Details
Approval Date
8/15/2012
Contract Begin Date
8/15/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/19/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nicholas Barcellona, CFO
(412) 232-8627
Contract Pharmacy Representative
Debra Krasnow, Director of Managed Care
(412) 968-1550
Signed By Date
8/24/2012
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