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GIANT EAGLE PHARMACY #0063
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 #0063
Pharmacy Address
4250 MURRAY AVENUE
PITTSBURGH, PA 15217
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
Eileen Simmons, CFO
(412) 647-7713
Contract Pharmacy Representative
Giant Eagle, Inc.
Mike Bianco, Senior Pharmacy Manager
(412) 967-3718
Signed By Date
1/18/2017
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