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UPMC MCKEESPORT OUTPATIENT PHARMACY
DSH390002 UPMC MCKEESPORT
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Covered Entity Details
Entity Name
UPMC MCKEESPORT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390002
Entity Address
1500 FIFTH AVENUE
MCKEESPORT, PA 15132
Medicare Provider Number
390002
Participating Start Date
4/1/2012
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
UPMC MCKEESPORT OUTPATIENT PHARMACY
Pharmacy Address
1500 5TH AVE
1 SHAW
MCKEESPORT, PA 15132-2422
Pharmacy Comments
Contract Details
Approval Date
4/15/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Christopher Stockhausen, CFO
(412) 664-2528
Contract Pharmacy Representative
UPMC McKeesport
WILLIAM R. NICCOLAI, DIRECTOR OF PHARMACY
(412) 664-2318
Signed By Date
4/15/2013
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