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GIANT EAGLE PHARMACY #1619
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
GIANT EAGLE PHARMACY #1619
Pharmacy Address
EDGEWOOD TOWNE CENTER
1705 SOUTH BRADDOCK AVE
PITTSBURGH, PA 15218
Pharmacy Comments
Contract Details
Approval Date
10/24/2013
Contract Begin Date
1/1/2014
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
Christopher Stockhausen, CFO
(412) 664-2528
Contract Pharmacy Representative
Brett L. Merrell, Senior Vice President, Health & Wellness
(412) 968-1550
Signed By Date
10/24/2013
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