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MARTIN'S PHARMACY #6290
DSH390184 Highlands Hospital
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Covered Entity Details
Entity Name
Highlands Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390184
Entity Address
401 East Murphy Ave.
Connellsville, PA 15425
Medicare Provider Number
390184
Participating Start Date
7/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
MARTIN'S PHARMACY #6290
Pharmacy Address
800 VANDERBILT RD
CONNELLSVILLE, PA 15425
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John S. Andursky, Chief Executive Officer
(724) 626-2359
Contract Pharmacy Representative
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
4/15/2022
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