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GIANT EAGLE PHARMACY #0018
PED393302-01 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
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Covered Entity Details
Entity Name
UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Subdivision Name
Outpatient Surgery
Type
Children's Hospital
340B ID
PED393302-01
Entity Address
2599 WEXFORD BAYNE ROAD
SEWICKLEY, PA 15143
Medicare Provider Number
393302
Outpatient Facility Provider Number
Participating Start Date
1/1/2010
Last Recertification Date
8/24/2023
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
GIANT EAGLE PHARMACY #0018
Pharmacy Address
1671 BUTLER PLANK
GLENSHAW, PA 15116
Pharmacy Comments
Contract Details
Approval Date
8/22/2012
Contract Begin Date
8/22/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Laurel Ragland, CFO
(412) 692-6242
Contract Pharmacy Representative
Debra Krasnow, Director of Managed Care
(412) 968-1550
Signed By Date
7/26/2012
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