Contract Pharmacy Details

GIANT EAGLE PHARMACY #0018
PED393302-03 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH

Covered Entity Details

Entity Name

UPMC CHILDREN'S HOSPITAL OF PITTSBURGH

Subdivision Name

SAME DAY SURGERY-MAIN HOSPITAL (SPU)

Type

Children's Hospital

340B ID

PED393302-03

Entity Address

4401 PENN AVENUE
PITTSBURGH, PA 15224

Medicare Provider Number

393302

Outpatient Facility Provider Number

Participating Start Date

1/1/2010

Last Recertification Date

9/1/2020

Entity Termination Date

10/1/2021

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

10/1/2021
Covered Entity Terminated

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

340B Drug Pricing Program Database