Contract Pharmacy Details

GIANT EAGLE PHARMACY #2404
DSH390114D UPMC Magee-Womens Hospital

Covered Entity Details

Entity Name

UPMC Magee-Womens Hospital

Subdivision Name

MAGEE AT MONROEVILLE

Type

Disproportionate Share Hospital

340B ID

DSH390114D

Entity Address

CORP ONE OFFICE PARK, BLDG 2
4075 MONROEVILLE BLVD
MONROEVILLE, PA 15146

Medicare Provider Number

390114

Outpatient Facility Provider Number

Participating Start Date

4/1/2003

Last Recertification Date

8/25/2023

Entity Termination Date

1/1/2024

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

5/14/2021
Covered Entity Terminated

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

340B Drug Pricing Program Database