PITTSBURGH (AP) — The University of Pittsburgh Medical Center has signed a letter of intent to affiliate with central Pennsylvania’s PinnacleHealth, even as that network plans to expand by purchasing four more hospitals.

PinnacleHealth, based in Harrisburg, announced the deal Tuesday.

UPMC has about 20 hospitals and is the state’s largest hospital network. PinnacleHealth already operates three hospitals, PinnacleHealth Harrisburg Hospital, PinnacleHealth Community General Osteopathic Hospital, also in Harrisburg, and PinnacleHealth West Short Hospital in Mechanicsburg. It’s also affiliated with J.C. Blair Health System in Huntingdon.

But now PinnacleHealth is hoping to buy Carlisle Regional Medical Center in Cumberland County; Memorial Hospital in York County; and Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center, both in Lancaster County.

The deals must be approved by federal and state regulators.

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