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HEIGHTS HEALTHMART PHARMACY
DSH390090E West Penn Hospital
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Covered Entity Details
Entity Name
West Penn Hospital
Subdivision Name
WEST PENN HOSPITAL OUTPATIENT SERVICES AT FORBES
Type
Disproportionate Share Hospital
340B ID
DSH390090E
Entity Address
2626 HAYMAKER RD
MONROEVILLE, PA 15146-3516
Medicare Provider Number
390090
Outpatient Facility Provider Number
Participating Start Date
1/1/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HEIGHTS HEALTHMART PHARMACY
Pharmacy Address
1633 UNION AVE
NATRONA HEIGHTS, PA 15065-2103
Pharmacy Comments
Contract Details
Approval Date
9/20/2012
Contract Begin Date
9/20/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Duke Rupert, CEO and President
(412) 578-1176
Contract Pharmacy Representative
Alex Micklow, Secretary
(724) 842-1771
Signed By Date
8/31/2012
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