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ALTOONA PHARMACY
DSH390178 UPMC HORIZON HOSPITAL
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Covered Entity Details
Entity Name
UPMC HORIZON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390178
Entity Address
110 NORTH MAIN STREET
GREENVILLE, PA 16125
Medicare Provider Number
390178
Participating Start Date
4/1/2017
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
ALTOONA PHARMACY
Pharmacy Address
ATTN: BRETTON WALBERG
620 HOWARD AVE STE 403
BLDG G SUITE 403
ALTOONA, PA 16601-4804
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Tracy, Jr., CFO
(724) 656-4107
Contract Pharmacy Representative
Care-Fill LTC
Bretton Walberg, President
(724) 588-6337
Signed By Date
1/14/2025
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