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GIANT EAGLE PHARMACY #2404
DSH390114 UPMC Magee-Womens Hospital
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Covered Entity Details
Entity Name
UPMC Magee-Womens Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390114
Entity Address
300 HALKET STREET
PITTSBURGH, PA 15213
Medicare Provider Number
390114
Participating Start Date
4/1/2003
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #2404
Pharmacy Address
200 ALLEGHENY RIVER BLVD
VERONA, PA 15147
Pharmacy Comments
Contract Details
Approval Date
8/24/2012
Contract Begin Date
8/24/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Gerad Theriac, CFO
(412) 641-4466
Contract Pharmacy Representative
Debra Krasnow, Director of Managed Care
(412) 968-1550
Signed By Date
8/10/2012
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