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WAL-MART PHARMACY 10-2588
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
WAL-MART PHARMACY 10-2588
Pharmacy Address
100 WAL-MART DRIVE
NORTH VERSAILLES, PA 15137
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Laurene Timmons, CFO
(412) 664-6781
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/12/2023
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