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CHARTWELL PENNSYLVANIA
DSH390178 UPMC HORIZON HOSPITAL
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Covered Entity Details
Entity Name
UPMC HORIZON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390178
Entity Address
110 NORTH MAIN STREET
GREENVILLE, PA 16125
Medicare Provider Number
390178
Participating Start Date
4/1/2017
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
CHARTWELL PENNSYLVANIA
Pharmacy Address
1001 OAKDALE RD
OAKDALE, PA 15071-1502
Pharmacy Comments
Contract Details
Approval Date
4/28/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas Newman, CFO
(412) 748-6354
Contract Pharmacy Representative
UPMC Pinnacle
Kathie Patrick, Manager
(412) 818-7665
Signed By Date
4/28/2017
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