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CHARTWELL PENNSYLVANIA
DSH390117 UPMC BEDFORD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
UPMC BEDFORD MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390117
Entity Address
10455 LINCOLN HIGHWAY
EVERETT, PA 15537
Medicare Provider Number
390117
Participating Start Date
4/1/2017
Last Recertification Date
11/7/2017
Entity Termination Date
1/1/2018
Pharmacy Details
Pharmacy Name
CHARTWELL PENNSYLVANIA
Pharmacy Address
1001 OAKDALE RD
OAKDALE, PA 15071-1502
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mario Edward Wilfong, CFO
(412) 692-8201
Contract Pharmacy Representative
UPMC Pinnacle
Kathie Patrick, Manager
(412) 818-7665
Signed By Date
4/14/2017
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