340B Drug Pricing Program Database


SCH390048-00 GEISINGER LEWISTOWN HOSPITAL (Terminated) - information as of 5/12/2025 10:06:40 PM

Main Details
GEISINGER LEWISTOWN HOSPITAL
Sole Community Hospital
Yes
SCH390048-00
390048


Additional Details
Terminated
4/8/2022
4/14/2022
4/14/2022
8/16/2024

1/1/2025
Change of covered entity type

Contacts

Geisinger Health
Michael Anthony Evans, VP Pharmacy CPO
(570) 271-6192

Geisinger Health
Lola Travelpiece, 340B Program Manager
(570) 214-1035

Addresses

400 HIGHLAND AVENUE
LEWISTOWN, PA 17044

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participating from effective date: (1/1/2019) until terminated effective date: (07/01/2021), reinstatement effective date: (04/14/2022)04/14/2022
Participated starting 7/1/2011; Terminated on 4/1/2012; Reinstated 1/1/2019.10/24/2018
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA1007506760041,1007506760043,1007506760023,1007506760045,1007506760046,1007506760050,10075067600041609263946,1639560550,1750778981,1861545683,1497338313,1801531322,1841970746
Shipping Addresses

Geisinger Lewistown
400 Highland Ave
Lewistown, PA 17044

Safecor
4060 Business Park Dr
ste B
Columbus, OH 43204

GSS Distribution Center
212 Industrial Park Rd
Elysburg, PA 17824

Geisinger Pharmacy
428 Windmere Dr
State College, PA 16801
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/14/202204/14/2022 01/10/202401/23/2024
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/14/202204/14/2022 01/10/202401/23/2024
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/14/202204/14/2022 01/10/202401/23/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/14/202204/14/2022 01/10/202401/23/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/14/202204/14/2022 01/10/202401/23/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/14/202204/14/2022 01/10/202401/23/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607504/14/202204/14/2022 01/10/202401/23/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280904/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/14/202204/14/2022 01/01/202501/01/2025
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/14/202204/14/2022 01/01/202501/01/2025
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/14/202204/14/2022 01/10/202401/23/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/14/202204/14/2022 01/10/202401/23/2024
Contract DetailGEISINGER HOME INFUSION SVCS44 WOODBINE LN
DANVILLEPA17821-802010/14/201901/01/2020 07/01/202107/01/2021
Contract DetailGEISINGER HOME INFUSION SVCS44 WOODBINE LN
DANVILLEPA17821-802004/14/202204/14/2022 01/01/202501/01/2025
Contract DetailGEISINGER HOME INFUSION SVCS.GEISINGER PHARMACY, LLC 428 WINDMERE DR
STATE COLLEGEPA1680104/14/202204/14/2022 01/01/202501/01/2025
Contract DetailGEISINGER LEWISTOWN HOSPITAL400 HIGHLAND AVE STE B
LEWISTOWNPA1704410/25/201801/01/2019 07/01/202107/01/2021
Contract DetailGEISINGER LEWISTOWN HOSPITAL400 HIGHLAND AVE STE B
LEWISTOWNPA1704404/14/202204/14/2022 01/01/202501/01/2025
Contract DetailGEISINGER MAIL ORDER PHARMACY210 INDUSTRIAL PARK ROAD
ELYSBURGPA17824-977004/14/202204/14/2022 01/01/202501/01/2025
Contract DetailGEISINGER PHARMACY21 GEISINGER LANE
LEWISTOWNPA17044-340010/25/201801/01/2019 07/01/202107/01/2021
Contract DetailGEISINGER PHARMACY21 GEISINGER LANE
LEWISTOWNPA17044-340004/14/202204/14/2022 01/01/202501/01/2025
Contract DetailGEISINGER PHARMACY132 ABIGAIL LN
PORT MATILDAPA1687004/04/202307/01/2023 01/01/202501/01/2025
Contract DetailGEISINGER SPECIALTY PHARMACY620 BALTIMORE DR STE 100
WILKES BARREPA1870210/25/201801/01/2019 07/01/202104/02/2024
Contract DetailGEISINGER SPECIALTY PHARMACY620 BALTIMORE DR STE 100
WILKES BARREPA1870204/14/202204/14/2022 01/01/202501/01/2025
Contract DetailGIANT PHARMACY #6055325 W. FREEDOM AVE, STE 150
BURNHAMPA1700904/14/202204/14/2022 12/12/202301/23/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01687 404 N. LOGAN BLVD.
BURNHAMPA1700904/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01684 127 SOUTH POTTER STREET
BELLEFONTEPA1682304/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01919 815 N. FRONT ST.
PHILIPSBURGPA1686604/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01681 311 BELLEFONTE AVE
LOCK HAVENPA1774504/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY #01677 33 EAST MARKET ST
LEWISTOWNPA1704404/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01688 1630 SOUTH ATHERTON STREET
STATE COLLEGEPA1680104/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01916 1101 NORTH ATHERTON STREET
STATE COLLEGEPA1680304/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPERFORMSPECIALTY, LLC2416 LAKE ORANGE DR. STE 190
ORLANDOFL3283710/15/202001/01/2021 07/01/202107/01/2021
Contract DetailPERFORMSPECIALTY, LLC2416 LAKE ORANGE DR. STE 190
ORLANDOFL3283704/14/202204/14/2022 01/01/202401/23/2024
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/14/202204/14/2022 01/01/202501/01/2025
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920304/14/202204/14/2022 01/01/202501/01/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1495 101 EAST SHIRLEY STREET
MOUNT UNIONPA1706604/12/202307/01/2023 11/12/202301/23/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #233 9635 WILLIAM PENN HIGHWAY
HUNTINGDONPA1665204/12/202307/01/2023 11/12/202301/23/2024
Contract DetailTHRIFT DRUG, INC.RITE AID #11015 821 EAST BISHOP STREET
BELLEFONTEPA1682304/12/202307/01/2023 11/12/202301/23/2024
Contract DetailTHRIFT DRUG, INC.RITE AID #11014 1536 NORTH ATHERTON STREET
STATE COLLEGEPA1680304/12/202307/01/2023 11/12/202301/23/2024
Contract DetailTHRIFT DRUG, INC.RITE AID #11013 510 WESTERLY PARKWAY
STATE COLLEGEPA1680104/12/202307/01/2023 11/12/202301/23/2024
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/14/201901/01/2020 01/01/202008/14/2020
Contract DetailWAL-MART PHARMACY 10-160710180 US HWY 522 SOUTH
LEWISTOWNPA1704410/14/201901/01/2020 01/01/202008/14/2020
Contract DetailWAL-MART PHARMACY 10-16401665 N ATHERTON PLACE
STATE COLLEGEPA1680310/14/201901/01/2020 01/01/202008/14/2020
Contract DetailWAL-MART PHARMACY 10-2230373 BENNER PIKE
STATE COLLEGEPA1680110/14/201901/01/2020 01/01/202008/14/2020
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/14/201901/01/2020 01/01/202008/14/2020
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
SCH390048-01ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - Rad Oncology Tech211 3RD STLEWISTOWNPATerminated
SCH390048-02ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - Gen Diagnostics RAD JVMC27 CJEMS LANEMIFFLINTOWNPATerminated
SCH390048-03ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - Cat Scanner JVMC Mobile27 CJEMS LANEMIFFLINTOWNPATerminated
SCH390048-04ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - Ultrasound JVMC mobile27 CJEMS LANEMIFFLINTOWNPATerminated
SCH390048-05ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - MRI JVMC Mobile27 CJEMS LANEMIFFLINTOWNPATerminated
SCH390048-06ChildSCHGEISINGER LEWISTOWN HOSPITALGeisinger Lewistown Hospital - Infectious Disease ACC310 Electric AveLewistownPATerminated
SCH390048-07ChildSCHGEISINGER LEWISTOWN HOSPITALGeisinger Lewistown Hospital - Gastro Electric Ave310 Electric AveLewistownPATerminated
SCH390048-08ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - CT Imaging MIfflintown27 CJEMS LANEMIFFLINTOWNPATerminated
SCH390048-09ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL ENDO - Endo GECL310 ELECTRIC AVELEWISTOWNPATerminated
SCH390048-10ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - OR OSSC132 ABIGAIL LNPORT MATILDAPATerminated
SCH390048-11ChildSCHGEISINGER LEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL - MR Imaging Mifflintown27 CJEMS LANEMIFFLINTOWNPATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated1/1/2025 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateHospital Type Change Request 1/1/2025 12:00:00 AM12/10/2024 11:36 AM
DetailsStateUpdateHospital Type Change RequestActiveTo Be Terminated12/10/2024 11:36 AM
TerminationsTermination DateUpdateHospital Type Change Request 1/1/2025 12:00:00 AM12/10/2024 11:36 AM
TerminationsTermination Effective DateUpdateHospital Type Change Request 1/1/2025 12:00:00 AM12/10/2024 11:36 AM
TerminationsTermination ReasonUpdateHospital Type Change Request Change of covered entity type12/10/2024 11:36 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007506760042 (PA) 8/16/2024 7:02 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007506760008 (PA) 8/16/2024 7:02 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/16/2024 7:02 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075067600468/16/2024 7:02 AM
Medicaid BillingMedicaid: StateInsertRecertification PA8/16/2024 7:02 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/16/2024 7:02 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075067600508/16/2024 7:02 AM
Medicaid BillingMedicaid: StateInsertRecertification PA8/16/2024 7:02 AM
Medicaid BillingNPI: NumberDeleteRecertification1558486928 (PA) 8/16/2024 7:02 AM
Medicaid BillingNPI: NumberDeleteRecertification1689061921 (PA) 8/16/2024 7:02 AM
Medicaid BillingNPI: NumberDeleteRecertification1831242114 (PA) 8/16/2024 7:02 AM
DetailsLast Recertification DateUpdateRecertification9/8/2023 2:08:03 PM8/16/2024 7:02:12 AM8/16/2024 7:02 AM
AddressesShipping AddressInsertRecertification Geisinger Pharmacy 428 Windmere Dr State College, PA 168019/8/2023 2:08 PM
Medicaid BillingNPI: NumberInsertRecertification 18419707469/8/2023 2:08 PM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2023 2:08 PM
DetailsLast Recertification DateUpdateRecertification8/29/2022 11:31:58 AM9/8/2023 2:08:03 PM9/8/2023 2:08 PM
ContactsAuthorizing OfficialUpdateAO Change RequestThomas, Kirk E Chief Administrative Officer Geisinger Lewistown Hospital 7172427102Evans, Michael Anthony VP Pharmacy CPO Geisinger Health 57027161929/8/2023 1:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/12/2023 11:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075067600456/12/2023 11:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA6/12/2023 11:00 AM
Medicaid BillingNPI: NumberInsertChange Request 18015313226/12/2023 11:00 AM
Medicaid BillingNPI: StateInsertChange Request PA6/12/2023 11:00 AM
ContactsPrimary ContactUpdateProfile Change RequestTravelpiece, Lola 340b Analyst Supervisor Geisinger Health 5702141035Travelpiece, Lola 340B Program Manager Geisinger Health 57021410359/26/2022 9:58 AM
DetailsLast Recertification DateUpdateRecertification 8/29/2022 11:31:58 AM8/29/2022 11:31 AM
DetailsStateUpdateOPA EditApprovedActive4/14/2022 8:29 AM
DatesStart DateUpdateOPA Edit7/1/2022 12:00:00 AM4/14/2022 12:00:00 AM4/14/2022 8:29 AM
Medicaid BillingNPI: NumberInsertReinstatement 14973383134/14/2022 8:13 AM
Medicaid BillingNPI: StateInsertReinstatement PA4/14/2022 8:13 AM
DetailsLast Recertification DateUpdateReinstatement9/10/2020 4:42:28 PM 4/14/2022 8:13 AM
DatesLast Date That 340B Drugs PurchasedUpdateReinstatement7/1/2021 12:00:00 AM 4/14/2022 8:13 AM
DatesParticipating Approval DateUpdateReinstatement10/25/2018 10:52:50 AM4/14/2022 8:13:45 AM4/14/2022 8:13 AM
DetailsStateUpdateReinstatementTerminatedApproved4/14/2022 8:13 AM
DatesRegistration DateUpdateReinstatement10/4/2018 12:41:31 PM4/8/2022 2:27:58 PM4/14/2022 8:13 AM
DatesSigned By DateUpdateReinstatement10/8/2018 3:17:39 PM4/11/2022 1:13:18 PM4/14/2022 8:13 AM
DatesStart DateUpdateReinstatement1/1/2019 12:00:00 AM7/1/2022 12:00:00 AM4/14/2022 8:13 AM
TerminationsTermination DateUpdateReinstatement7/1/2021 12:00:00 AM 4/14/2022 8:13 AM
TerminationsTermination Effective DateUpdateReinstatement7/1/2021 12:00:00 AM 4/14/2022 8:13 AM
TerminationsTermination ReasonUpdateReinstatementChange of covered entity type 4/14/2022 8:13 AM
DetailsComments PublicInsertReinstatement Participating from effective date: (1/1/2019) until terminated effective date: (07/01/2021), reinstatement effective date: (04/14/2022)4/14/2022 7:14 AM
DetailsStateUpdate To Be TerminatedTerminated7/1/2021 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateHospital Type Change Request 7/1/2021 12:00:00 AM4/19/2021 12:27 PM
DetailsStateUpdateHospital Type Change RequestActiveTo Be Terminated4/19/2021 12:27 PM
TerminationsTermination DateUpdateHospital Type Change Request 7/1/2021 12:00:00 AM4/19/2021 12:27 PM
TerminationsTermination Effective DateUpdateHospital Type Change Request 7/1/2021 12:00:00 AM4/19/2021 12:27 PM
TerminationsTermination ReasonUpdateHospital Type Change Request Change of covered entity type4/19/2021 12:27 PM
Medicaid BillingNPI: NumberDeleteRecertification1558486928 ( ) 9/10/2020 4:42 PM
Medicaid BillingNPI: NumberDeleteRecertification1639560550 ( ) 9/10/2020 4:42 PM
Medicaid BillingNPI: NumberDeleteRecertification1689061921 ( ) 9/10/2020 4:42 PM
Medicaid BillingNPI: NumberInsertRecertification 15584869289/10/2020 4:42 PM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 4:42 PM
Medicaid BillingNPI: NumberInsertRecertification 16092639469/10/2020 4:42 PM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 4:42 PM
Medicaid BillingNPI: NumberInsertRecertification 16395605509/10/2020 4:42 PM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 4:42 PM
Medicaid BillingNPI: NumberInsertRecertification 16890619219/10/2020 4:42 PM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 4:42 PM
Medicaid BillingNPI: NumberInsertRecertification 17507789819/10/2020 4:42 PM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 4:42 PM
Medicaid BillingNPI: NumberInsertRecertification 18312421149/10/2020 4:42 PM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 4:42 PM
Medicaid BillingNPI: NumberInsertRecertification 18615456839/10/2020 4:42 PM
Medicaid BillingNPI: StateInsertRecertification PA9/10/2020 4:42 PM
Medicaid BillingNPI: NumberDeleteRecertification1861545683 ( ) 9/10/2020 4:42 PM
Medicaid BillingNPI: NumberDeleteRecertification1831242114 ( ) 9/10/2020 4:42 PM
Medicaid BillingNPI: NumberDeleteRecertification1609263946 ( ) 9/10/2020 4:42 PM
Medicaid BillingNPI: NumberDeleteRecertification1750778981 ( ) 9/10/2020 4:42 PM
DetailsLast Recertification DateUpdateRecertification9/5/2019 11:58:03 AM9/10/2020 4:42:28 PM9/10/2020 4:42 PM
ContactsPrimary ContactUpdateChange RequestGuschel, Timothy 340B Program Director Geisinger Health 5702140155Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 57021410356/2/2020 8:32 AM
DetailsLast Recertification DateUpdateRecertification 9/5/2019 11:58:03 AM9/5/2019 11:58 AM
Medicaid BillingNPI: NumberInsertChange Request 15584869287/15/2019 1:28 PM
Medicaid BillingNPI: NumberInsertChange Request 16395605507/15/2019 1:28 PM
Medicaid BillingNPI: NumberInsertChange Request 16890619217/15/2019 1:28 PM
AddressesShipping AddressInsertChange Request Geisinger Lewistown 400 Highland Ave Lewistown, PA 170445/9/2019 9:46 AM
AddressesShipping AddressInsertChange Request Safecor 4060 Business Park Dr ste B Columbus, OH 432045/9/2019 9:46 AM
AddressesShipping AddressInsertChange Request GSS Distribution Center 212 Industrial Park Rd Elysburg, PA 178245/9/2019 9:46 AM
DetailsStateUpdate ApprovedActive1/1/2019 12:05 AM
ContactsPrimary ContactUpdateReinstatementSTOMACKIN, RICH DIRECTOR OF PHARMACY 7172427277Guschel, Timothy 340B Program Director Geisinger Health 570214015510/25/2018 10:52 AM
ContactsAuthorizing OfficialUpdateReinstatementTHOMAS, KIRK VICE PRESIDENT FOR OPERATIONS 7172427105Thomas, Kirk E Chief Administrative Officer Geisinger Lewistown Hospital 717242710210/25/2018 10:52 AM
ContactsSigned ByInsertReinstatement Thomas, Kirk E Chief Administrative Officer Geisinger Lewistown Hospital 717242710210/25/2018 10:52 AM
DetailsEntity NameUpdateReinstatementLEWISTOWN HOSPITALGEISINGER LEWISTOWN HOSPITAL10/25/2018 10:52 AM
DatesParticipating Approval DateUpdateReinstatement 10/25/2018 10:52:50 AM10/25/2018 10:52 AM
DetailsStateUpdateReinstatementPendingApproved10/25/2018 10:52 AM
DatesSigned By DateUpdateReinstatement5/20/2011 12:00:00 AM10/8/2018 3:17:39 PM10/25/2018 10:52 AM
DatesStart DateUpdateReinstatement 1/1/2019 12:00:00 AM10/25/2018 10:52 AM
DetailsComments PublicInsertReinstatement Participated starting 7/1/2011; Terminated on 4/1/2012; Reinstated 1/1/2019.10/24/2018 9:26 AM
AddressesMain AddressUpdateReinstatement 400 HIGHLAND AVE LEWISTOWN, PA 17044 400 HIGHLAND AVENUE LEWISTOWN, PA 1704410/4/2018 4:41 PM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False10/4/2018 4:41 PM
Medicaid BillingMedicaid: NumberInsertReinstatement 100750676004110/4/2018 4:41 PM
Medicaid BillingMedicaid: StateInsertReinstatement PA10/4/2018 4:41 PM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False10/4/2018 4:41 PM
Medicaid BillingMedicaid: NumberInsertReinstatement 100750676004210/4/2018 4:41 PM
Medicaid BillingMedicaid: StateInsertReinstatement PA10/4/2018 4:41 PM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False10/4/2018 4:41 PM
Medicaid BillingMedicaid: NumberInsertReinstatement 100750676004310/4/2018 4:41 PM
Medicaid BillingMedicaid: StateInsertReinstatement PA10/4/2018 4:41 PM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False10/4/2018 4:41 PM
Medicaid BillingMedicaid: NumberInsertReinstatement 100750676000810/4/2018 4:41 PM
Medicaid BillingMedicaid: StateInsertReinstatement PA10/4/2018 4:41 PM
Medicaid BillingMedicaid: Is PrimaryInsertReinstatement False10/4/2018 4:41 PM
Medicaid BillingMedicaid: NumberInsertReinstatement 100750676002310/4/2018 4:41 PM
Medicaid BillingMedicaid: StateInsertReinstatement PA10/4/2018 4:41 PM
Medicaid BillingNPI: NumberInsertReinstatement 186154568310/4/2018 4:41 PM
Medicaid BillingNPI: NumberInsertReinstatement 183124211410/4/2018 4:41 PM
Medicaid BillingNPI: NumberInsertReinstatement 160926394610/4/2018 4:41 PM
Medicaid BillingNPI: NumberInsertReinstatement 175077898110/4/2018 4:41 PM
DatesParticipating Approval DateUpdateReinstatement6/8/2011 12:00:00 AM 10/4/2018 12:41 PM
DetailsStateUpdateReinstatementTerminatedPending10/4/2018 12:41 PM
DatesRegistration DateUpdateReinstatement5/16/2011 12:00:00 AM10/4/2018 12:41:31 PM10/4/2018 12:41 PM
DatesStart DateUpdateReinstatement7/1/2011 12:00:00 AM 10/4/2018 12:41 PM
TerminationsTermination DateUpdateReinstatement4/1/2012 12:00:00 AM 10/4/2018 12:41 PM
TerminationsTermination ReasonUpdateReinstatementAt request of covered entity 10/4/2018 12:41 PM
ContactsAuthorizing OfficialInsert  THOMAS, KIRK VICE PRESIDENT FOR OPERATIONS 71724271057/3/2014 4:20 PM
ContactsPrimary ContactInsert  STOMACKIN, RICH DIRECTOR OF PHARMACY 71724272777/3/2014 4:20 PM
AddressesMain AddressInsert   400 HIGHLAND AVE LEWISTOWN, PA 170443/23/2012 10:39 AM
DetailsStateUpdate ActiveTerminated3/23/2012 10:39 AM
TerminationsTermination DateUpdate  4/1/2012 12:00:00 AM3/23/2012 10:39 AM
TerminationsTermination ReasonUpdate  At request of covered entity3/23/2012 10:39 AM
DetailsLast Recertification DateInsert   6/8/2011 12:53 PM
DetailsGrant NumberInsert   6/8/2011 12:53 PM
Details340B IDInsert  SCH390048-006/8/2011 12:53 PM
DetailsIs Authorizing Official EHB DataInsert   6/8/2011 12:53 PM
DatesLast Date That 340B Drugs PurchasedInsert   6/8/2011 12:53 PM
DetailsMedicare Provider NumberInsert  3900486/8/2011 12:53 PM
DetailsEntity NameInsert  LEWISTOWN HOSPITAL6/8/2011 12:53 PM
DetailsProgram CodeInsert  SCH6/8/2011 12:53 PM
DetailsEntity SubnameInsert   6/8/2011 12:53 PM
DatesParticipating Approval DateInsert  6/8/2011 12:00:00 AM6/8/2011 12:53 PM
DetailsStateInsert  Active6/8/2011 12:53 PM
DatesRegistration DateInsert  5/16/2011 12:00:00 AM6/8/2011 12:53 PM
DatesSigned By DateInsert  5/20/2011 12:00:00 AM6/8/2011 12:53 PM
DatesStart DateInsert  7/1/2011 12:00:00 AM6/8/2011 12:53 PM
TerminationsTermination CommentsInsert   6/8/2011 12:53 PM
TerminationsTermination DateInsert   6/8/2011 12:53 PM
TerminationsTermination Effective DateInsert   6/8/2011 12:53 PM
TerminationsTermination ReasonInsert   6/8/2011 12:53 PM
Medicaid BillingMedicaid: Is PrimaryInsert  True5/16/2011 4:12 PM
Medicaid BillingMedicaid: NumberInsert  10075067600045/16/2011 4:12 PM
Medicaid BillingMedicaid: StateInsert  PA5/16/2011 4:12 PM