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CARE-FILL LTC
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
CARE-FILL LTC
Pharmacy Address
28 CONNEAUT LAKE RD
GREENVILLE, PA 16125
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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