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WAL-MART PHARMACY 10-5315
DSH390164 UPMC - PRESBYTERIAN SHADYSIDE
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Covered Entity Details
Entity Name
UPMC - PRESBYTERIAN SHADYSIDE
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390164
Entity Address
200 LOTHROP STREET
PITTSBURGH, PA 15213
Medicare Provider Number
390164
Participating Start Date
4/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5315
Pharmacy Address
2354 COMMERCE PARK DR.
ORLANDO, FL 32819
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Weiner, CFO, UPMC Presbyterian Shadyside
(412) 864-7000
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
7/17/2023
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