340B Drug Pricing Program Database


DSH390270 GEISINGER WYOMING VALLEY MED CTR (Active) - information as of 5/19/2025 12:52:16 AM

Main Details
GEISINGER WYOMING VALLEY MED CTR
Disproportionate Share Hospital
Yes
DSH390270
390270


Additional Details
Active
4/3/2017
7/1/2017
4/7/2017
8/27/2024

Contacts

Geisinger Wyoming Valley Medical Center
Ron Beer, Chief Admiistrative Officer
(570) 808-5380

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

Addresses

1000 EAST MOUNTAIN BLVD
WILKES BARRE, PA 18711

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA1007584780022,1007584780026,1007584780016,1007584780023,1007584780019,1007584780017,1007584780014,1007584780021,1007535151333,1007584780002,1007584780008,1007584780009,1007584780012,1007584780027,1007584780030,1007584780033,1007584780029,1007584780032,1007584780038,10075847800401205197894,1104292960,1669768214,1912332511,1770953994,1649568403,1235424672,1447538640,1881980803,1437551868,1275620585,1649305129,1669553624,1174822068,1316692585,1457959124,1780253336,1942769393,1487683348,1831930338,1922860360,1164274247
Shipping Addresses

Geisinger Pharmacy
1000 East Mountain Blvd
Wilkes Barre, PA 18711

Geisinger Wyoming Valley Medical Center
1000 EAST MOUNTAIN BLVD
Wilkes Barre, PA 18711

Geisinger South Wilkes Barre
25 Church St
Wilkes Barre, PA 18765

GSS Distribution Center
212 Industrial Park Rd
Elysburg, PA 17824

Safecor
4060 Business Park Dr
ste B
Columbus, OH 43204

Geisinger Healthplex Centerpoint Pharmacy
1201 Oak St
Pittston, PA 18640-3798

Geisinger Pharmacy MOB
950 East Mountain Blvd
Wilkes Barre, PA 18711
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884904/16/201807/01/2018  04/16/2018
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750204/16/201807/01/2018  04/16/2018
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201004/16/201807/01/2018  04/16/2018
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624104/16/201807/01/2018 01/01/202403/27/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349204/16/201807/01/2018  04/16/2018
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282204/16/201807/01/2018  04/16/2018
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/17/202204/01/2022  04/01/2022
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280910/04/201701/01/2018  08/28/2018
Contract DetailBIOPLUS SPECIALTY PHARMACY LA, LLC2731 MANHATTAN BLVD STE B17
HARVEYLA7005801/13/201904/01/2019 12/18/202204/13/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY, INC3200 LAKE EMMA RD UNIT 1000
LAKE MARYFL3274601/13/201904/01/2019 12/18/202204/13/2023
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361410/04/201701/01/2018 12/08/201712/11/2017
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005610/04/201701/01/2018  08/28/2018
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621910/04/201701/01/2018  08/28/2018
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175710/04/201701/01/2018 12/08/201712/11/2017
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808310/04/201701/01/2018 12/08/201712/11/2017
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700410/04/201701/01/2018  08/28/2018
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761710/04/201701/01/2018  08/28/2018
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813310/04/201701/01/2018 12/08/201712/11/2017
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237410/04/201701/01/2018 12/08/201712/11/2017
Contract DetailCARESITE PHARMACY1000 E Mountain Drive
Wilkes BarrePA1871104/20/201707/01/2017 10/01/201710/19/2017
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/13/202307/01/2023  07/01/2023
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/13/202307/01/2023  07/01/2023
Contract DetailECKERD CORPORATIONRITE AID #11081 556 UNION STREET
LUZERNEPA1870904/12/202207/01/2022 02/28/202503/07/2025
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607510/13/202101/01/2022  01/01/2022
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801610/13/202101/01/2022  01/01/2022
Contract DetailGEISINGER HOME INFUSION SVCS44 WOODBINE LN
DANVILLEPA17821-802010/24/201810/24/2018  11/26/2018
Contract DetailGEISINGER HOME INFUSION SVCS620 BALTIMORE DRIVE SUITE 210
WILKES BARREPA1870210/15/202401/01/2025  01/01/2025
Contract DetailGEISINGER HOME INFUSION SVCS.GEISINGER PHARMACY, LLC 428 WINDMERE DR
STATE COLLEGEPA1680101/17/202204/01/2022  04/01/2022
Contract DetailGEISINGER MAIL ORDER PHARMACY210 INDUSTRIAL PARK ROAD
ELYSBURGPA17824-977004/20/201707/01/2017  02/23/2021
Contract DetailGEISINGER PHARMACY175 SOUTH WILKES BARRE BLVD
WILKES BARREPA18702-504004/20/201707/01/2017  03/02/2021
Contract DetailGEISINGER PHARMACY114 LT MICHAEL CLEARY DR
DALLASPA18612-164904/20/201707/01/2017  02/23/2021
Contract DetailGEISINGER PHARMACY126 MARKET WAY
MOUNT POCONOPA1834404/05/201807/01/2018  02/23/2021
Contract DetailGEISINGER SPECIALTY PHARMACY620 BALTIMORE DR STE 100
WILKES BARREPA1870204/20/201707/01/2017  02/23/2021
Contract DetailGIANT PHARMACY #612150 BRIAR CREEK PLAZA
BERWICKPA1860301/17/202204/01/2022 08/20/202409/18/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01616 960 WYOMING AVE.
EXETERPA1864304/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01594 5 CHURCH STREET
DALLASPA1861204/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01614 702 SANS SOUCI PARKWAY
WILKES BARREPA1870604/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02133 620 MARKET STREET
KINGSTONPA1870404/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA CVS/PHARMACY # 10128 500 CENTRE ST
FREELANDPA1822404/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02262 5674 ROUTE 115
BLAKESLEEPA1861004/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01588 1096 WYOMING AVE
MIDWAY S/C
WYOMINGPA1864404/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01891 64 S. LOCUST ST
SUITE 180
HAZLETONPA1820104/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01584 555 EAST MAIN STREET
NANTICOKEPA1863404/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01591 351 S. MAIN ST.
WILKES BARREPA1870104/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 02729 351 KENNEDY BLVD
PITTSTONPA1864004/16/201807/01/2018  04/16/2018
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01585 125 EAST MAIN STREET
PLYMOUTHPA1865104/13/202307/01/2023  07/01/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01617 50 BRIDGE STREET
TUNKHANNOCKPA1865704/13/202307/01/2023  07/01/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16966 3400 WILKES-BARRE TOWNSHIP COMMONS
WILKES BARRE TOWNSHIPPA1870204/13/202307/01/2023  07/01/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01583 1 NORTH MAIN STREET
SHICKSHINNYPA1865504/13/202307/01/2023  07/01/2023
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06790 509 DAVIS STREET
SCRANTONPA1850504/13/202307/01/2023  07/01/2023
Contract DetailPERFORMSPECIALTY, LLC2416 LAKE ORANGE DR. STE 190
ORLANDOFL3283710/15/202001/01/2021 01/01/202403/27/2024
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514610/04/201701/01/2018  08/28/2018
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1632 20 SOUTH RIVER STREET
PLAINSPA1870504/12/202207/01/2022 02/28/202503/07/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #2568 1988 MEMORIAL HWY
SHAVERTOWNPA1870804/12/202207/01/2022 02/28/202503/07/2025
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #4990 2 KIRBY AVENUE
MOUNTAIN TOPPA1870704/12/202207/01/2022 02/28/202503/07/2025
Contract DetailVITALINE PHARMACY44 WOODBINE LANE
DANVILLEPA17822-240107/05/201710/01/2017 10/24/201810/24/2018
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738601/15/201904/01/2019  04/01/2019
Contract DetailWAL-MART PHARMACY 10-16232150 WILKES-BARRE TWP MKTPL
WILKES-BARREPA1870210/03/201901/01/2020  01/01/2020
Contract DetailWAL-MART PHARMACY 10-1884900 COMMERCE BLVD
DICKSON CITYPA1851901/15/201904/01/2019 04/01/201909/16/2019
Contract DetailWAL-MART PHARMACY 10-2024808 HUNTER HWY
TUNKHANNOCKPA1865701/15/201904/01/2019  04/01/2019
Contract DetailWAL-MART PHARMACY 10-2255761 AIRPORT RD
HAZLE TOWNSHIPPA1820101/15/201904/01/2019  04/01/2019
Contract DetailWAL-MART PHARMACY 10-2543390 HWY 315
PITTSTONPA18640-379801/15/201904/01/2019  04/01/2019
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283701/15/201904/01/2019  04/01/2019
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/14/202010/01/2020  10/01/2020
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH390270AChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Valley Medical Building / General Surgery Amb Care Fac1000 East Mountain BlvdWilkes BarrePAActive
DSH390270AAChildDSHGEISINGER WYOMING VALLEY MED CTRMaternal-Fetal Med Ambulatory Care Clinic190 WELLES STREETFORTY FORTPAActive
DSH390270ABChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL / Urgent Care South Wilkes Barre Ambulatory Care Clinic25 CHURCH STREETWILKES BARREPAActive
DSH390270ACChildDSHGEISINGER WYOMING VALLEY MED CTROrthopaedics Ambulatory Care Center1175 EAST MOUNTAIN DRIVEWILKES BARREPAActive
DSH390270ADChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Hem Onc Mt Pocono126 MARKET WAYMT POCONOPAActive
DSH390270AEChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Hem Onc Tunkhannock809 Hunter HwyTUNKHANNOCKPAActive
DSH390270AGChildDSHGEISINGER WYOMING VALLEY MED CTRUrology Ambulatory Care Clinic1000 East Mountain BlvdWilkes BarrePAActive
DSH390270AHChildDSHGEISINGER WYOMING VALLEY MED CTRPodiatry1155 East Mountain DriveWilkes BarrePAActive
DSH390270AJChildDSHGEISINGER WYOMING VALLEY MED CTRNeurophysiology950 EAST MOUNTAIN DRIVEWILKES BARREPAActive
DSH390270AKChildDSHGEISINGER WYOMING VALLEY MED CTRGastroenterology Ambulatory Care Clinic675 Baltimore DrWilkes BarrePAActive
DSH390270ALChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL - Recovery Room South Wilkes Barre25 CHURCH STREETWILKES BARREPAActive
DSH390270AMChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL - Anesthesia Hospital South Wilkes Barre25 CHURCH STREETWILKES BARREPATerminated
DSH390270ANChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL - Operating Rooms South Wilkes Barre25 CHURCH STREETWILKES BARREPAActive
DSH390270APChildDSHGEISINGER WYOMING VALLEY MED CTRMRI Tunhannock - MRI Tunhannock809 Hunter HwyTunkhannockPAActive
DSH390270AQChildDSHGEISINGER WYOMING VALLEY MED CTRGeneral Diagnostic Radiology 1000 E Mountain Dr - General Diagnostic Radiology1000 East Mountain BlvdWilkes BarrePAActive
DSH390270ARChildDSHGEISINGER WYOMING VALLEY MED CTRCat Scanner Tunkhannock - Cat Scanner Tunkhannock809 Hunter HwyTunkhannockPAActive
DSH390270ASChildDSHGEISINGER WYOMING VALLEY MED CTRTunkhannock Hunter HWY XR Imaging809 Hunter HwyTunkhannockPAActive
DSH390270ATChildDSHGEISINGER WYOMING VALLEY MED CTRGeneral Diagnostic Radiology South Wilkes Barre - General Diagnostic Radiology South Wilkes Barre25 Church StWilkes BarrePAActive
DSH390270AUChildDSHGEISINGER WYOMING VALLEY MED CTRMT TOP XR Imaging35 S MOUNTAIN BLVDMOUNTAIN TOPPAActive
DSH390270AVChildDSHGEISINGER WYOMING VALLEY MED CTRMRI Mt Pocono - MRI Mt Pocono126 Market WayMt PoconoPAActive
DSH390270AWChildDSHGEISINGER WYOMING VALLEY MED CTRXR Imaging Dallas114 Lt.Michael Cleary DrDallasPAActive
DSH390270AXChildDSHGEISINGER WYOMING VALLEY MED CTRXR Imaging Mt Pocono126 Market WayMt PoconoPAActive
DSH390270AYChildDSHGEISINGER WYOMING VALLEY MED CTRCat Scanner South Wilkes Barre - Cat Scanner South Wilkes Barre25 Church StWilkes BarrePATerminated
DSH390270AZChildDSHGEISINGER WYOMING VALLEY MED CTRCat Scanner Mt Pocono - Cat Scanner Mt Pocono126 Market WayMt PoconoPATerminated
DSH390270BChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Valley Medical Building / Gastroenterology Amb Care950 East Mountain DriveWilkes BarrePAActive
DSH390270BAChildDSHGEISINGER WYOMING VALLEY MED CTRXR Imaging Pittston42 North Main StPittstonPAActive
DSH390270BBChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger South Wilkes Barre - Sleep Disorder Center Lab SWB25 CHURCH STREETWILKES BARREPAActive
DSH390270BCChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL - RESP THERAPY PULMONARY SWB25 CHURCH STREETWILKES BARREPATerminated
DSH390270BDChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL - 5 South Med Surg GSWB- Observation Beds25 CHURCH STREETWILKES BARREPAActive
DSH390270BEChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL - Urology Ambulatory Care Clinic (ACC) South Wilkes Barre (SWB)25 CHURCH STREETWILKES BARREPAActive
DSH390270BFChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL - Emergency Room South Wilkes Barre (SWB)25 CHURCH STREETWILKES BARREPAActive
DSH390270BGChildDSHGEISINGER WYOMING VALLEY MED CTRORTHOPEDICS 1155 E MTN BLVD WB - ORTHOPEDICS1155 E MOUNTAIN BLVDWILKES BARREPATerminated
DSH390270BHChildDSHGEISINGER WYOMING VALLEY MED CTRPULM FUNCTION LAB BALTIMORE DRIVE - PULMONARY MEDICINE620 BALTIMORE DRIVEWILKES BARREPAActive
DSH390270BJChildDSHGEISINGER WYOMING VALLEY MED CTRNEUROLOGY BALTIMORE DR WB - NEUROLOGY620 BALTIMORE DRIVEWILKES BARREPAActive
DSH390270BKChildDSHGEISINGER WYOMING VALLEY MED CTRNEUROPSYCHOLOGY BALTIMORE DR - NEUROPSYCHOLOGY620 BALTIMORE DRIVEWILKES BARREPAActive
DSH390270BLChildDSHGEISINGER WYOMING VALLEY MED CTRCardiac Studies SWB - Cardiac Studies25 Church StWilkes BarrePAActive
DSH390270BMChildDSHGEISINGER WYOMING VALLEY MED CTRCARDIAC REHAB GWV - CARDIOLOGY675 BALTIMORE DRWILKES BARREPAActive
DSH390270BNChildDSHGEISINGER WYOMING VALLEY MED CTRConvenient Care Plus GSWV - Convenient Care25 Church StWilkes BarrePAActive
DSH390270BPChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - Nephrology950 East Mountain DriveWilkes BarrePAActive
DSH390270BQChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - Phys Therapy Pittston1201 OAK STPITTSTONPAActive
DSH390270BRChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - CT Imaging SWB25 CHURCH STREETWILKES BARREPAActive
DSH390270BSChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - MR Imaging Mt Pocono126 Market WayMount PoconoPAActive
DSH390270BTChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - Pulmonary950 East Mountain DriveWilkes BarrePAActive
DSH390270BUChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - Vascular Surgery950 East Mountain DriveWilkes BarrePAActive
DSH390270BVChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - Infectious Disease950 East Mountain DriveWilkes BarrePAActive
DSH390270BWChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - Urology Pittston1201 OAK STPITTSTONPAActive
DSH390270BXChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - Pediatric Neurology950 East Mountain DriveWilkes BarrePAActive
DSH390270BYChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - Occup Therapy Pittston1201 OAK STPITTSTONPAActive
DSH390270BZChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - Lab Pittston1201 OAK STPITTSTONPAActive
DSH390270CChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Valley Medical Building / Neurology Amb Care Fac950 East Mountain DriveWilkes BarrePAActive
DSH390270CAChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - ENT/ Audiology950 East Mountain DriveWilkes BarrePAActive
DSH390270CBChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - GYN Urology SWB25 CHURCH STREETWILKES BARREPAActive
DSH390270CCChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - CT Imaging Pittston1201 OAK STPITTSTONPAActive
DSH390270CDChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - MR Imaging Pittston1201 OAK STPITTSTONPAActive
DSH390270CEChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - US Imaging Pittston1201 OAK STPITTSTONPAActive
DSH390270CFChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - MR Imaging SWB25 CHURCH STREETWILKES BARREPAActive
DSH390270CGChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - Orthopaedics Pittston1201 OAK STPITTSTONPAActive
DSH390270CHChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - XR Imaging Pittston1201 OAK STPITTSTONPAActive
DSH390270CJChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - CT Imaging Mt Pocono126 Market WayMount PoconoPAActive
DSH390270CKChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Med Ctr - General Surgery950 East Mountain DriveWilkes BarrePAActive
DSH390270CLChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Neuropsychology ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CMChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Dermatology ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CNChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Peds Pulmonary ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CPChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Endocrinology ACC Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CQChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Pediatric Fetal Echo West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CRChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Audiology W Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CSChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Ped Neurology ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CTChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Peds Allergy ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CUChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - MFM Imaging ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CVChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - OR OSCP1201 OAK STPITTSTONPAActive
DSH390270CWChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - OB GYN ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CXChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Neurology ACC Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CYChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Urogynecology ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270CZChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Maternal Fetal Med ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270DChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Valley Medical Building / Thoracic Medicine Amb Care1000 East Mountain DriveWilkes BarrePAActive
DSH390270DAChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER HEALTHPLEX CENTERPOINT - Ophthalmology ACC Healthplex CenterPoint1201 OAK STPITTSTONPAActive
DSH390270DBChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Adult Echocardiography Roosevelt Terrace50 ROOSEVELT TERRACEWILKES -BARREPAActive
DSH390270DCChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Clinical Nutrition Olive St3 W OLIVE STSCRANTONPAActive
DSH390270DDChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Neurosurgery ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270DEChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - MOHS Surgery ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270DFChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley MOB - Vascular Ultrasound MOB950 East Mountain BlvdWilkes BarrePAActive
DSH390270DGChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Ultrasound ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270DHChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Otolaryngology ACC West Olive St3 W OLIVE STSCRANTONPAActive
DSH390270DJChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Neurophysiology Olive St3 W OLIVE STSCRANTONPAActive
DSH390270DKChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE - Gastroenterology ACC West Olive St.3 W OLIVE STSCRANTONPAActive
DSH390270DLChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley MOB - GWV MOB XR Imaging950 East Mountain BlvdWilkes BarrePAActive
DSH390270DMChildDSHGEISINGER WYOMING VALLEY MED CTRGeneral Radiology East Mountain Dr - General Radiology1155 East Mountain BlvdWilkes BarrePAActive
DSH390270EChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Valley Medical Building / Thoracic Surg Amb1000 East Mountain DriveWilkes BarrePAActive
DSH390270FChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Valley Medical Building / Transplant Surgery Ambulatory Care Clinic950 East Mountain DriveWilkes BarrePAActive
DSH390270GChildDSHGEISINGER WYOMING VALLEY MED CTRGeisinger Wyoming Valley Medical Building / Neurosurgery Amb Care Fac950 East Mountain DriveWilkes BarrePAActive
DSH390270HChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Otolaryngology Amb Care Fac950 East Mountain DriveWilkes BarrePAActive
DSH390270JChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Plastic Surgery Ambulatory Care Center675 BALITMORE DRWILKES BARREPAActive
DSH390270KChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Ophthalmology Amb Care Fac675 BALTIMORE DR.WILKES BARREPAActive
DSH390270LChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Dental Med/Oral Surg Ambulatory Care Clinic675 BALTIMORE DRWILKES BARREPAActive
DSH390270MChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Rheumatology Amb Care Fac675 BALTIMORE DRWILKES BARREPAActive
DSH390270NChildDSHGEISINGER WYOMING VALLEY MED CTRGastro Nutrition Ambulatory Care675 BALTIMORE DRWILKES BARREPAActive
DSH390270PChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Endocrinology Amb Care Fac675 BALTIMORE DRWILKES BARREPAActive
DSH390270QChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Infectious Disease Ambulatory Care Clinic675 BALTIMORE DRWILKES BARREPATerminated
DSH390270RChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Reproductive Endocrinology1155 EAST MOUNTAIN BLVDWILKES-BARREPAActive
DSH390270SChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / UROGYN Ambulatory Care Center1155 EAST MOUNTAIN DRIVEWILKES-BARREPAActive
DSH390270TChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / OB Gynecology Amb Care Fac1155 EAST MOUNTAIN DriveWILKES-BARREPAActive
DSH390270UChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / General Internal Med Ambulatory Care Center660 Baltimore DriveWILKES-BARREPAActive
DSH390270VChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL CE / Dermatolgy AMB Care Fac1155 EAST MOUNTAIN DRIVEWILKES-BARREPAActive
DSH390270WChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL / OB Gynecology Ambulatory Care Center South Wilkes Barre25 CHURCH STREETWILKES BARREPAActive
DSH390270XChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL / Pain Mgmt Ambulatory Care Center South Wilkes Barre25 CHURCH STREETWILKES BARREPAActive
DSH390270YChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL / Adult Psychiatry AMB Clinic Care South Wilkes Barre25 CHURCH STREETWILKES BARREPAActive
DSH390270ZChildDSHGEISINGER WYOMING VALLEY MED CTRGEISINGER WYOMING VALLEY MEDICAL / Peds Urgent Care South Wilkes Barre25 CHURCH STREETWILKES BARREPAActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False3/7/2025 2:17 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 10075847800403/7/2025 2:17 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA3/7/2025 2:17 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 11642742473/7/2025 2:17 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA3/7/2025 2:17 PM
AddressesShipping AddressUpdateChange RequestGeisinger Pharmacy 1000 East Mountain Drive Wilkes Barre, PA 18711Geisinger Pharmacy 1000 East Mountain Blvd Wilkes Barre, PA 187119/18/2024 11:18 AM
AddressesShipping AddressUpdateChange RequestGeisinger Wyoming Valley Medical Center 1000 EAST MOUNTAIN DRIVE Wilkes Barre, PA 18711Geisinger Wyoming Valley Medical Center 1000 EAST MOUNTAIN BLVD Wilkes Barre, PA 187119/18/2024 11:18 AM
AddressesShipping AddressUpdateChange RequestGeisinger South Wilkes Barre 25 Chruch St Wilkes Barre, PA 18765Geisinger South Wilkes Barre 25 Church St Wilkes Barre, PA 187659/18/2024 11:18 AM
AddressesShipping AddressUpdateChange RequestGeisinger Pharmacy MOB 950 East Mountain Drive Wilkes Barre, PA 18711Geisinger Pharmacy MOB 950 East Mountain Blvd Wilkes Barre, PA 187119/18/2024 11:18 AM
AddressesMain AddressUpdateChange Request 1000 EAST MOUNTAIN DRIVE WILKES BARRE, PA 18711 1000 EAST MOUNTAIN BLVD WILKES BARRE, PA 187119/18/2024 11:18 AM
AddressesShipping AddressInsertRecertification Geisinger Pharmacy MOB 950 East Mountain Drive Wilkes Barre, PA 187118/27/2024 4:02 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/27/2024 4:02 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800328/27/2024 4:02 PM
Medicaid BillingMedicaid: StateInsertRecertification PA8/27/2024 4:02 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False8/27/2024 4:02 PM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800388/27/2024 4:02 PM
Medicaid BillingMedicaid: StateInsertRecertification PA8/27/2024 4:02 PM
Medicaid BillingNPI: NumberDeleteRecertification1861791865 (PA) 8/27/2024 4:02 PM
Medicaid BillingNPI: NumberInsertRecertification 18319303388/27/2024 4:02 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2024 4:02 PM
Medicaid BillingNPI: NumberInsertRecertification 19228603608/27/2024 4:02 PM
Medicaid BillingNPI: StateInsertRecertification PA8/27/2024 4:02 PM
DetailsLast Recertification DateUpdateRecertification9/3/2023 10:20:33 AM8/27/2024 4:02:39 PM8/27/2024 4:02 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 186179186512/18/2023 12:58 PM
Medicaid BillingNPI: StateInsertGroup Change Request PA12/18/2023 12:58 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1007535151275 (PA) 12/15/2023 3:24 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False12/15/2023 3:24 PM
Medicaid BillingMedicaid: NumberInsertChange Request 100758478002912/15/2023 3:24 PM
Medicaid BillingMedicaid: StateInsertChange Request PA12/15/2023 3:24 PM
Medicaid BillingNPI: NumberDeleteChange Request1861791865 (PA) 12/15/2023 3:24 PM
AddressesShipping AddressUpdateChange RequestGeisinger Pharmacy 1000 E Mountain BLVD Wilkes Barre, PA 18711Geisinger Pharmacy 1000 East Mountain Drive Wilkes Barre, PA 187119/7/2023 6:49 AM
AddressesShipping AddressUpdateChange RequestGeisinger Wyoming Valley Medical Center 1000 EAST MOUNTAIN BLVD Wilkes Barre, PA 18711Geisinger Wyoming Valley Medical Center 1000 EAST MOUNTAIN DRIVE Wilkes Barre, PA 187119/7/2023 6:49 AM
AddressesMain AddressUpdateChange Request 1000 EAST MOUNTAIN BLVD WILKES BARRE, PA 18711 1000 EAST MOUNTAIN DRIVE WILKES BARRE, PA 187119/7/2023 6:49 AM
DetailsLast Recertification DateUpdateRecertification9/2/2022 9:27:25 AM9/3/2023 10:20:33 AM9/3/2023 10:20 AM
Medicaid BillingMedicaid: NumberDeleteChange Request1007584780013 (PA) 6/12/2023 6:12 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/12/2023 6:12 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800336/12/2023 6:12 PM
Medicaid BillingMedicaid: StateInsertChange Request PA6/12/2023 6:12 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/12/2023 6:12 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10075351512756/12/2023 6:12 PM
Medicaid BillingMedicaid: StateInsertChange Request PA6/12/2023 6:12 PM
Medicaid BillingNPI: NumberInsertChange Request 19427693936/12/2023 6:12 PM
Medicaid BillingNPI: StateInsertChange Request PA6/12/2023 6:12 PM
Medicaid BillingNPI: NumberInsertChange Request 14876833486/12/2023 6:12 PM
Medicaid BillingNPI: StateInsertChange Request PA6/12/2023 6:12 PM
AddressesShipping AddressUpdateChange RequestGeisinger Pharmacy 1000 E Mountain Drive Wilkes Barre, PA 18711Geisinger Pharmacy 1000 E Mountain BLVD Wilkes Barre, PA 187114/26/2023 9:19 AM
AddressesShipping AddressUpdateChange RequestGeisinger Wyoming Valley Medical Center 1000 EAST MOUNTAIN DRIVE Wilkes Barre, PA 18711Geisinger Wyoming Valley Medical Center 1000 EAST MOUNTAIN BLVD Wilkes Barre, PA 187114/26/2023 9:19 AM
AddressesMain AddressUpdateChange Request 1000 EAST MOUNTAIN DRIVE WILKES BARRE, PA 18711 1000 EAST MOUNTAIN BLVD WILKES BARRE, PA 187114/26/2023 9:19 AM
ContactsPrimary ContactUpdateProfile Change RequestTravelpiece, Lola 340b Analyst Supervisor Geisinger Health 5702141035Travelpiece, Lola 340B Program Manager Geisinger Health 57021410359/26/2022 9:58 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780018 (PA) 9/2/2022 9:27 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780015 (PA) 9/2/2022 9:27 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780020 (PA) 9/2/2022 9:27 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780029 (PA) 9/2/2022 9:27 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/2/2022 9:27 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800279/2/2022 9:27 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/2/2022 9:27 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/2/2022 9:27 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800309/2/2022 9:27 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/2/2022 9:27 AM
Medicaid BillingNPI: NumberDeleteRecertification1265728810 (PA) 9/2/2022 9:27 AM
Medicaid BillingNPI: NumberDeleteRecertification1093001653 (PA) 9/2/2022 9:27 AM
Medicaid BillingNPI: NumberDeleteRecertification1760777106 (PA) 9/2/2022 9:27 AM
Medicaid BillingNPI: NumberDeleteRecertification1487683348 (PA) 9/2/2022 9:27 AM
Medicaid BillingNPI: NumberInsertRecertification 13166925859/2/2022 9:27 AM
Medicaid BillingNPI: StateInsertRecertification PA9/2/2022 9:27 AM
Medicaid BillingNPI: NumberInsertRecertification 14579591249/2/2022 9:27 AM
Medicaid BillingNPI: StateInsertRecertification PA9/2/2022 9:27 AM
Medicaid BillingNPI: NumberInsertRecertification 17802533369/2/2022 9:27 AM
Medicaid BillingNPI: StateInsertRecertification PA9/2/2022 9:27 AM
DetailsLast Recertification DateUpdateRecertification9/1/2021 9:08:16 AM9/2/2022 9:27:25 AM9/2/2022 9:27 AM
AddressesShipping AddressUpdateChange RequestCaresite Pharmacy 1000 E Mountain Drive Wilkes Barre, PA 18711Geisinger Pharmacy 1000 E Mountain Drive Wilkes Barre, PA 187118/11/2022 8:31 AM
AddressesShipping AddressInsertChange Request Geisinger Healthplex Centerpoint Pharmacy 1201 Oak St Pittston, PA 18640-37988/11/2022 8:31 AM
DetailsLast Recertification DateUpdateRecertification9/8/2020 10:07:58 AM9/1/2021 9:08:16 AM9/1/2021 9:08 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780016 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780019 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780025 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780017 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780023 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780012 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780026 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780020 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780014 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780021 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780022 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800229/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800269/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800169/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800189/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800239/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800199/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800179/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800149/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800219/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075351513339/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800159/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800029/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800089/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800099/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800209/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800129/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800139/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberInsertRecertification 10075847800299/8/2020 10:07 AM
Medicaid BillingMedicaid: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780002 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007535151275 (PA) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification4201400 (NJ) 9/8/2020 10:07 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007584780029 (PA) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1265728810 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1770953994 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1669553624 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1861791865 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 12051978949/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 11042929609/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 16697682149/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 12657288109/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 19123325119/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 17709539949/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 16495684039/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 12354246729/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 14475386409/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 18819808039/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 14375518689/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 10930016539/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 12756205859/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 16493051299/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 16695536249/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 17607771069/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 11748220689/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 18617918659/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberInsertRecertification 14876833489/8/2020 10:07 AM
Medicaid BillingNPI: StateInsertRecertification PA9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1275620585 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1487683348 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1669768214 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1649305129 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1649568403 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1437551868 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1205197894 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1235424672 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1912332511 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1760777106 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1447538640 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1881980803 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1104292960 ( ) 9/8/2020 10:07 AM
Medicaid BillingNPI: NumberDeleteRecertification1174822068 ( ) 9/8/2020 10:07 AM
DetailsLast Recertification DateUpdateRecertification8/22/2019 1:15:57 PM9/8/2020 10:07:58 AM9/8/2020 10:07 AM
ContactsPrimary ContactUpdateChange RequestGuschel, Timothy 340B Program Director Geisinger Health 5702140155Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 57021410352/28/2020 8:44 AM
DetailsLast Recertification DateUpdateRecertification8/20/2018 8:27:20 AM8/22/2019 1:15:57 PM8/22/2019 1:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/11/2019 1:58 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800227/11/2019 1:58 PM
Medicaid BillingMedicaid: StateInsertChange Request PA7/11/2019 1:58 PM
Medicaid BillingNPI: NumberInsertChange Request 12657288106/30/2019 9:19 PM
Medicaid BillingNPI: NumberInsertChange Request 17709539946/30/2019 9:19 PM
Medicaid BillingNPI: NumberInsertChange Request 16695536246/30/2019 9:19 PM
Medicaid BillingNPI: NumberInsertChange Request 18617918656/30/2019 9:19 PM
AddressesShipping AddressInsertChange Request GSS Distribution Center 212 Industrial Park Rd Elysburg, PA 178245/7/2019 12:12 PM
AddressesShipping AddressInsertChange Request Safecor 4060 Business Park Dr ste B Columbus, OH 432045/7/2019 12:12 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1007584780022 (PA) 1/23/2019 10:46 AM
Medicaid BillingNPI: NumberInsertChange Request 11042929601/23/2019 10:46 AM
Medicaid BillingNPI: NumberInsertChange Request 11748220681/23/2019 10:46 AM
Medicaid BillingMedicaid: NumberUpdateChange Request100758478002210075847800021/22/2019 2:10 PM
Medicaid BillingMedicaid: NumberUpdateChange Request1007584780002210075847800221/15/2019 11:23 AM
Medicaid BillingMedicaid: NumberDeleteChange Request1007584780029 (PA) 1/15/2019 11:23 AM
AddressesShipping AddressInsertChange Request Geisinger South Wilkes Barre 25 Chruch St Wilkes Barre, PA 187659/4/2018 10:07 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800169/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800199/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800259/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800229/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800179/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800239/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800129/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800269/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800209/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800149/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/4/2018 8:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800219/4/2018 8:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA9/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 16697682149/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 16493051299/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 16495684039/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 14375518689/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 12051978949/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 12354246729/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 19123325119/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 17607771069/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 14475386409/4/2018 8:00 AM
Medicaid BillingNPI: NumberInsertChange Request 18819808039/4/2018 8:00 AM
DetailsLast Recertification DateUpdateRecertification11/14/2017 9:39:47 AM8/20/2018 8:27:20 AM8/20/2018 8:27 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False7/19/2018 8:46 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800297/19/2018 8:46 AM
Medicaid BillingMedicaid: StateInsertChange Request PA7/19/2018 8:46 AM
ContactsPrimary ContactUpdateProfile Change RequestGuschel, Timothy 340B Program Director Geisinger Health System 5702140155Guschel, Timothy 340B Program Director Geisinger Health 57021401556/28/2018 10:45 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/28/2018 11:33 AM
Medicaid BillingMedicaid: NumberInsertChange Request 10075847800293/28/2018 11:33 AM
Medicaid BillingMedicaid: StateInsertChange Request PA3/28/2018 11:33 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False2/8/2018 8:47 AM
Medicaid BillingMedicaid: NumberInsertChange Request 42014002/8/2018 8:47 AM
Medicaid BillingMedicaid: StateInsertChange Request NJ2/8/2018 8:47 AM
DetailsLast Recertification DateUpdateRecertification 11/14/2017 9:39:47 AM11/14/2017 9:39 AM
AddressesShipping AddressInsertChange Request Caresite Pharmacy 1000 E Mountain Drive Wilkes Barre, PA 1871110/18/2017 8:11 AM
AddressesShipping AddressInsertChange Request Geisinger Wyoming Valley Medical Center 1000 EAST MOUNTAIN DRIVE Wilkes Barre, PA 1871110/18/2017 8:11 AM
ContactsPrimary ContactUpdateProfile Change RequestGuschel, TImothy 340B Program Director Geisinger Health System 5702140155Guschel, Timothy 340B Program Director Geisinger Health System 570214015510/5/2017 12:11 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False10/4/2017 10:00 AM
Medicaid BillingMedicaid: NumberInsertChange Request 100753515127510/4/2017 10:00 AM
Medicaid BillingMedicaid: StateInsertChange Request PA10/4/2017 10:00 AM
Medicaid BillingNPI: NumberInsertChange Request 148768334810/4/2017 10:00 AM
ContactsAuthorizing OfficialUpdate Beer, Ron Chief Admiistrative Officer 5708085380Beer, Ron Chief Admiistrative Officer Geisinger Wyoming Valley Medical Center 57080853809/19/2017 4:51 PM
ContactsPrimary ContactUpdate Guschel, TImothy 340B Program Director 5702140155Guschel, TImothy 340B Program Director Geisinger Health System 57021401559/18/2017 4:18 PM
ContactsPrimary ContactInsert  Guschel, TImothy 340B Program Director 57021401557/6/2017 9:17 AM
ContactsAuthorizing OfficialInsert  Beer, Ron Chief Admiistrative Officer 57080853807/5/2017 1:38 PM
ContactsSigned ByInsert  Beer, Ron Chief Admiistrative Officer 57080853805/15/2017 9:13 AM
AddressesMain AddressInsert   1000 EAST MOUNTAIN DRIVE WILKES BARRE, PA 187115/11/2017 7:18 AM
DatesParticipating Approval DateUpdate  4/7/2017 12:00:00 AM4/7/2017 1:54 PM
DetailsStateUpdate PendingActive4/7/2017 1:54 PM
DatesStart DateUpdate  7/1/2017 12:00:00 AM4/7/2017 1:54 PM
Details340B IDUpdate ONLINE_REG_75720DSH3902704/4/2017 10:42 AM
Details340B IDUpdate  ONLINE_REG_757204/3/2017 9:34 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False4/3/2017 9:34 AM
Medicaid BillingMedicaid: NumberInsert  100758478000224/3/2017 9:34 AM
Medicaid BillingMedicaid: StateInsert  PA4/3/2017 9:34 AM
Medicaid BillingNPI: NumberInsert  12756205854/3/2017 9:34 AM
DetailsLast Recertification DateInsert   4/3/2017 9:34 AM
DetailsGrant NumberInsert   4/3/2017 9:34 AM
Details340B IDInsert   4/3/2017 9:34 AM
DetailsIs Authorizing Official EHB DataInsert   4/3/2017 9:34 AM
DatesLast Date That 340B Drugs PurchasedInsert   4/3/2017 9:34 AM
DetailsMedicare Provider NumberInsert  3902704/3/2017 9:34 AM
DetailsEntity NameInsert  GEISINGER WYOMING VALLEY MED CTR4/3/2017 9:34 AM
DetailsProgram CodeInsert  DSH4/3/2017 9:34 AM
DetailsEntity SubnameInsert   4/3/2017 9:34 AM
DatesParticipating Approval DateInsert   4/3/2017 9:34 AM
DetailsStateInsert  Pending4/3/2017 9:34 AM
DatesRegistration DateInsert  4/3/2017 12:00:00 AM4/3/2017 9:34 AM
DatesSigned By DateInsert  4/3/2017 12:00:00 AM4/3/2017 9:34 AM
DatesStart DateInsert   4/3/2017 9:34 AM
TerminationsTermination CommentsInsert   4/3/2017 9:34 AM
TerminationsTermination DateInsert   4/3/2017 9:34 AM
TerminationsTermination Effective DateInsert   4/3/2017 9:34 AM
TerminationsTermination ReasonInsert   4/3/2017 9:34 AM