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CHARTWELL PENNSYLVANIA
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
CHARTWELL PENNSYLVANIA
Pharmacy Address
1001 OAKDALE RD
OAKDALE, PA 15071-1502
Pharmacy Comments
Contract Details
Approval Date
10/29/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Stockhausen, CFO
(412) 664-2528
Contract Pharmacy Representative
UPMC Pinnacle
Kathie Patrick, Manager
(412) 818-7665
Signed By Date
10/29/2014
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