340B Drug Pricing Program Database


RRC390001-00 COMMUNITY MEDICAL CENTER (Active) - information as of 6/24/2025 12:03:46 AM

Main Details
COMMUNITY MEDICAL CENTER
Rural Referral Center
Yes
RRC390001-00
390001


Additional Details
Active
10/10/2023
1/1/2024
11/27/2023
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

1800 MULBERRY STREET
SCRANTON, PA 18510

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
Participated starting 7/1/2019; Terminated 4/1/2022; Reinstated 1/1/2024.11/27/2023
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA1007456760006,1007456760023,1007456760032,1007456760040,1007456760035,10074567600411366444507,1770960130,1972652063,1245823764,1548648272
Shipping Addresses

Community Medical Center Pharmacy
1822 Mulberry St
Scranton, PA 18510

GSS Distribution Center
212 Industrial Park Rd
Elysburg, PA 17824

SAFECOR
4060 BUSINESS PARK DR STE B
COLOMBUS, OH 43204

Community Medical Center
316 Colfax Ave
Scranton, PA 18510

Community Medical Center
DBA Geisinger Phy Scranton
1800 Mulberry St
Scranton, PA 18510
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
MEMPHISTN38134-884911/27/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201011/27/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750211/27/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349211/27/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624111/27/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282211/27/202301/01/2024  01/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607511/27/202301/01/2024  01/01/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280911/27/202301/01/2024  01/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY, INC3200 LAKE EMMA RD UNIT 1000
LAKE MARYFL3274601/15/202104/01/2021 04/01/202204/01/2022
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/22/202110/01/2021 04/01/202204/01/2022
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361411/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005611/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621911/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/22/202110/01/2021 04/01/202204/01/2022
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175711/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/22/202110/01/2021 04/01/202204/01/2022
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808311/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700411/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761711/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813311/27/202301/01/2024  01/01/2024
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237407/22/202110/01/2021 04/01/202204/01/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237411/27/202301/01/2024  01/01/2024
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870611/27/202301/01/2024  01/01/2024
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005611/27/202301/01/2024  01/01/2024
Contract DetailDEPIETRO'S PHARMACY617 3RD ST
DUNMOREPA18512-284904/12/202107/01/2021 04/01/202204/01/2022
Contract DetailDEPIETRO'S PHARMACY617 3RD ST
DUNMOREPA18512-284911/27/202301/01/2024 11/30/202403/07/2025
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607511/27/202301/01/2024  01/01/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801611/27/202301/01/2024  01/01/2024
Contract DetailGEISINGER HOME INFUSION SVCS44 WOODBINE LN
DANVILLEPA17821-802010/11/201901/01/2020 04/01/202204/01/2022
Contract DetailGEISINGER HOME INFUSION SVCS44 WOODBINE LN
DANVILLEPA17821-802011/27/202301/01/2024  01/01/2024
Contract DetailGEISINGER HOME INFUSION SVCS620 BALTIMORE DRIVE SUITE 210
WILKES BARREPA1870210/15/202401/01/2025  01/01/2025
Contract DetailGEISINGER MAIL ORDER PHARMACY210 INDUSTRIAL PARK ROAD
ELYSBURGPA17824-977004/16/201907/01/2019 04/01/202204/01/2022
Contract DetailGEISINGER MAIL ORDER PHARMACY210 INDUSTRIAL PARK ROAD
ELYSBURGPA17824-977011/27/202301/01/2024  01/01/2024
Contract DetailGEISINGER PHARMACY531 MT PLEASANT DR
SCRANTONPA18503-198704/16/201907/01/2019 04/01/202204/01/2022
Contract DetailGEISINGER PHARMACY531 MT PLEASANT DR
SCRANTONPA18503-198711/27/202301/01/2024  01/01/2024
Contract DetailGEISINGER SPECIALTY PHARMACY620 BALTIMORE DR STE 100
WILKES BARREPA1870204/16/201907/01/2019 04/01/202204/01/2022
Contract DetailGEISINGER SPECIALTY PHARMACY620 BALTIMORE DR STE 100
WILKES BARREPA1870211/27/202301/01/2024  01/01/2024
Contract DetailGIANT PHARMACY18331 LEAMAN FARM ROAD
GERMANTOWNMD2087410/13/202101/01/2022 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01593 110 GREEN RIDGE STREET
SCRANTONPA1850907/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01188 101 S. MAIN ST.
OLD FORGEPA1851807/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16806 1140 COMMERCE BLVD
DICKSON CITYPA1851907/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00558 1008 SOUTH MAIN STREET
SCRANTONPA1850407/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01615 1600 MAIN ST.
DICKSON CITYPA1851907/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01611 1101 MOOSIC ST.
SCRANTONPA1850507/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01617 50 BRIDGE STREET
TUNKHANNOCKPA1865707/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01597 101 NORTH STATE STREET
CLARKS SUMMITPA1841107/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06790 509 DAVIS STREET
SCRANTONPA1850507/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01587 202 4TH STREET
HONESDALEPA1843107/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00053 58 WELWOOD AVE
HAWLEYPA1842807/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01600 88 BROOKLYN ST.
CARBONDALEPA1840707/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01612 347-349 BLAKELY STREET
DUNMOREPA1851207/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00748 657 HAMLIN HWY.
LAKE ARIELPA1843607/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01593 110 GREEN RIDGE STREET
SCRANTONPA1850911/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16806 1140 COMMERCE BLVD
DICKSON CITYPA1851911/27/202301/01/2024 11/30/202403/07/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06790 509 DAVIS STREET
SCRANTONPA1850511/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01597 101 NORTH STATE STREET
CLARKS SUMMITPA1841111/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01612 347-349 BLAKELY STREET
DUNMOREPA1851211/27/202301/01/2024 11/30/202403/07/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00748 657 HAMLIN HWY.
LAKE ARIELPA1843611/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01587 202 4TH STREET
HONESDALEPA1843111/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00558 1008 SOUTH MAIN STREET
SCRANTONPA1850411/27/202301/01/2024 11/30/202403/07/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01188 101 S. MAIN ST.
OLD FORGEPA1851811/27/202301/01/2024 11/30/202403/07/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01611 1101 MOOSIC ST.
SCRANTONPA1850511/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00053 58 WELWOOD AVE
HAWLEYPA1842811/27/202301/01/2024 11/30/202403/07/2025
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01615 1600 MAIN ST.
DICKSON CITYPA1851911/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01617 50 BRIDGE STREET
TUNKHANNOCKPA1865711/27/202301/01/2024  01/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01600 88 BROOKLYN ST.
CARBONDALEPA1840711/27/202301/01/2024  01/01/2024
Contract DetailPERFORMSPECIALTY, LLC2416 LAKE ORANGE DR. STE 190
ORLANDOFL3283710/13/202001/01/2021 04/01/202204/01/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/22/202110/01/2021 04/01/202204/01/2022
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514611/27/202301/01/2024  01/01/2024
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523311/27/202301/01/2024  01/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3470 580 CARBONDALE ROAD
SCOTT TOWNSHIPPA1844711/27/202301/01/2024 07/22/202409/18/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1426 1650 MAIN STREET
OLYPHANTPA1844711/27/202301/01/2024 07/22/202409/18/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1021 401-403 SOUTH MAIN STREET
OLD FORGEPA1851811/27/202301/01/2024 07/22/202409/18/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #7878 1050 NORTHERN BLVD
CLARKS SUMMITPA1841111/27/202301/01/2024 07/22/202409/18/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #726 1080 S WASHINGTON AVENUE
SCRANTONPA1850511/27/202301/01/2024 07/22/202409/18/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1180 217 SOUTH BLAKELY STREET
DUNMOREPA1851211/27/202301/01/2024 07/22/202409/18/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3775 500 NORTH MAIN AVENUE
SCRANTONPA1850411/27/202301/01/2024 07/22/202409/18/2024
Contract DetailTHE PRESCRIPTION CENTER310 ADAMS AVE
SCRANTONPA1850304/05/202107/01/2021 04/01/202204/01/2022
Contract DetailTHE PRESCRIPTION CENTER310 ADAMS AVE
SCRANTONPA1850311/27/202301/01/2024 12/31/202403/07/2025
Contract DetailTHRIFT DRUG, INC.RITE AID #11069 1777 NORTH KEYSER AVENUE
SCRANTONPA1850811/27/202301/01/2024 07/22/202409/18/2024
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738610/15/202001/01/2021 04/01/202204/01/2022
Contract DetailWAL-MART PHARMACY 10-1884900 COMMERCE BLVD
DICKSON CITYPA1851910/15/202001/01/2021 04/01/202204/01/2022
Contract DetailWAL-MART PHARMACY 10-2024808 HUNTER HWY
TUNKHANNOCKPA1865710/15/202001/01/2021 04/01/202204/01/2022
Contract DetailWAL-MART PHARMACY 10-2480723A OLD WILLOW AVE
HONESDALEPA1843110/15/202001/01/2021 04/01/202204/01/2022
Contract DetailWAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283710/15/202001/01/2021 04/01/202204/01/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527507/13/202010/01/2020 04/01/202204/01/2022
Contract DetailWALMART PHARMACY 10-42761325 MAIN ST.
TAYLORPA1851710/15/202001/01/2021 04/01/202204/01/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
RRC390001-01ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - GEN DIAGNOSTIC RAD VMT435 SCRANTON CARBONDALE HIGHWAYSCRANTONPATerminated
RRC390001-02ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - CAT SCANNER VIEWMONT435 SCRANTON CARBONDALE HIGHWAYSCRANTONPAActive
RRC390001-03ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - MT PLEASANT RADIOLOGY531 MT PLEASANT DRIVESCRANTONPATerminated
RRC390001-04ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - OCCUP THERAPY OP VIEWMONT423 SCRANTON-CARBONDALE HIGHWAYSCRANTONPATerminated
RRC390001-05ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - MRI VIEWMONT435 SCRANTON CARBONDALE HIGHWAYSCRANTONPAActive
RRC390001-06ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - MT PLEASANT MAMMOGRAPHY531 MT PLEASANT DRIVESCRANTONPATerminated
RRC390001-07ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - PHYSICAL THERAPY OP VIEWMONT423 SCRANTON-CARBONDALE HIGHWAYSCRANTONPATerminated
RRC390001-08ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - ULTRASOUND VIEWMONT435 SCRANTON CARBONDALE HIGHWAYSCRANTONPATerminated
RRC390001-09ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - NUCLEAR MEDICINE VMT5 MORGAN HIGHWAY SUITE 7SCRANTONPATerminated
RRC390001-10ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - MAMMOGRAPHY VIEWMONT435 SCRANTON CARBONDALE HIGHWAYSCRANTONPATerminated
RRC390001-11ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - MT PLEASANT ULTRASOUND531 MT PLEASANT DRIVESCRANTONPATerminated
RRC390001-12ChildRRCCOMMUNITY MEDICAL CENTERNeurology W. Olive St - Neurology3 West Olive StreetScrantonPATerminated
RRC390001-13ChildRRCCOMMUNITY MEDICAL CENTERNeurophysiology W. Olive St. - Neurophysiology3 West Olive StreetScrantonPATerminated
RRC390001-14ChildRRCCOMMUNITY MEDICAL CENTEROtolaryngology ACC W Olive St - Otolaryngology3 West Olive StreetScrantonPATerminated
RRC390001-15ChildRRCCOMMUNITY MEDICAL CENTERDermatology ACC W Olive St. - Dermatology3 West Olive StScrantonPATerminated
RRC390001-16ChildRRCCOMMUNITY MEDICAL CENTEREndocrinology W. Olive St. - Endocrinology3 West Olive StreetScrantonPATerminated
RRC390001-17ChildRRCCOMMUNITY MEDICAL CENTERGastroenterology ACC Olive St - Gastroenterology ACC Olive St.3 West Olive StScrantonPATerminated
RRC390001-18ChildRRCCOMMUNITY MEDICAL CENTERUrogyn ACC W. Olive St - Urogyn3 West Olive StreetScrantonPATerminated
RRC390001-19ChildRRCCOMMUNITY MEDICAL CENTERGeisinger Community Medical Center - Audiology W Olive St3 West Olive StScrantonPATerminated
RRC390001-20ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - PET Imaging Viewmont5 Morgan HwySCRANTONPAActive
RRC390001-21ChildRRCCOMMUNITY MEDICAL CENTERGeisinger Community Medical Center - GYN OB W Olive St3 West Olive StScrantonPATerminated
RRC390001-22ChildRRCCOMMUNITY MEDICAL CENTERGeisinger Community Medical Center - OB US Imaging W Olive St3 West Olive StScrantonPATerminated
RRC390001-23ChildRRCCOMMUNITY MEDICAL CENTERGEISINGER COMMUNITY MEDICAL CENTER - XR Imaging Viewmont435 SCRANTON CARBONDALE HWYSCRANTONPAActive
RRC390001-26ChildRRCCOMMUNITY MEDICAL CENTERGeisinger Community Medical Center - GYN Urology W Olive St3 West Olive StScrantonPATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
Medicaid BillingMedicaid: NumberDeleteGroup Change Request1007456760036 (PA) 12/16/2024 4:17 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False12/16/2024 4:17 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 100745676004112/16/2024 4:17 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA12/16/2024 4:17 PM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request1007456760041 (PA) 10/15/2024 11:46 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False10/15/2024 11:46 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 100745676003510/15/2024 11:46 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA10/15/2024 11:46 AM
Medicaid BillingNPI: NumberDeleteGroup Change Request1124405592 (PA) 10/15/2024 11:46 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 154864827210/15/2024 11:46 AM
Medicaid BillingNPI: StateInsertGroup Change Request PA10/15/2024 11:46 AM
Medicaid BillingMedicaid: NumberDeleteRecertification1007456760020 (PA) 8/27/2024 12:16 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1007456760031 (PA) 8/27/2024 12:16 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1007456760037 (PA) 8/27/2024 12:16 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1007456760033 (PA) 8/27/2024 12:16 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1007456760035 (PA) 8/27/2024 12:16 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1007456760039 (PA) 8/27/2024 12:16 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1007456760042 (PA) 8/27/2024 12:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1265495394 (PA) 8/27/2024 12:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1285032128 (PA) 8/27/2024 12:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1336526276 (PA) 8/27/2024 12:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1417334350 (PA) 8/27/2024 12:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1467850149 (PA) 8/27/2024 12:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1548648272 (PA) 8/27/2024 12:16 PM
Medicaid BillingNPI: NumberDeleteRecertification1306439856 (PA) 8/27/2024 12:16 PM
DetailsLast Recertification DateUpdateRecertification 8/27/2024 12:16:29 PM8/27/2024 12:16 PM
DetailsStateUpdate ApprovedActive1/1/2024 12:01 AM
Medicaid BillingMedicaid: NumberDeleteGroup Change Request1007456760005 (PA) 12/15/2023 3:15 PM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False12/15/2023 3:15 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 100745676004112/15/2023 3:15 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request PA12/15/2023 3:15 PM
DetailsComments PublicInsertOPA Edit Participated starting 7/1/2019; Terminated 4/1/2022; Reinstated 1/1/2024.11/27/2023 12:52 PM
Medicaid BillingMedicaid: NumberDeleteHospital Type Change Request1007456760034 (PA) 11/27/2023 12:51 PM
Medicaid BillingMedicaid: NumberDeleteHospital Type Change Request1007456760038 (PA) 11/27/2023 12:51 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False11/27/2023 12:51 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 100745676004011/27/2023 12:51 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA11/27/2023 12:51 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False11/27/2023 12:51 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 100745676004211/27/2023 12:51 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA11/27/2023 12:51 PM
Medicaid BillingNPI: NumberDeleteHospital Type Change Request1255540647 (PA) 11/27/2023 12:51 PM
Medicaid BillingNPI: NumberDeleteHospital Type Change Request1326446253 (PA) 11/27/2023 12:51 PM
Medicaid BillingNPI: NumberDeleteHospital Type Change Request1497132336 (PA) 11/27/2023 12:51 PM
Medicaid BillingNPI: NumberDeleteHospital Type Change Request1689015489 (PA) 11/27/2023 12:51 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 130643985611/27/2023 12:51 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA11/27/2023 12:51 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 124582376411/27/2023 12:51 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA11/27/2023 12:51 PM
DetailsLast Recertification DateUpdateHospital Type Change Request9/1/2021 9:16:03 AM 11/27/2023 12:51 PM
DatesLast Date That 340B Drugs PurchasedUpdateHospital Type Change Request4/1/2022 12:00:00 AM 11/27/2023 12:51 PM
DatesParticipating Approval DateUpdateHospital Type Change Request4/16/2019 12:39:21 PM11/27/2023 12:51:17 PM11/27/2023 12:51 PM
DetailsStateUpdateHospital Type Change RequestTerminatedApproved11/27/2023 12:51 PM
DatesRegistration DateUpdateHospital Type Change Request4/4/2019 11:47:08 AM10/10/2023 2:24:43 PM11/27/2023 12:51 PM
DatesSigned By DateUpdateHospital Type Change Request4/10/2019 12:23:11 PM11/9/2023 2:18:38 PM11/27/2023 12:51 PM
DatesStart DateUpdateHospital Type Change Request7/1/2019 12:00:00 AM1/1/2024 12:00:00 AM11/27/2023 12:51 PM
TerminationsTermination DateUpdateHospital Type Change Request4/1/2022 12:00:00 AM 11/27/2023 12:51 PM
TerminationsTermination Effective DateUpdateHospital Type Change Request4/1/2022 12:00:00 AM 11/27/2023 12:51 PM
TerminationsTermination ReasonUpdateHospital Type Change RequestChange of covered entity type 11/27/2023 12:51 PM
ContactsPrimary ContactUpdateProfile Change RequestTravelpiece, Lola 340b Analyst Supervisor Geisinger Health 5702141035Travelpiece, Lola 340B Program Manager Geisinger Health 57021410359/26/2022 9:58 AM
DetailsStateUpdate To Be TerminatedTerminated4/1/2022 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateHospital Type Change Request 4/1/2022 12:00:00 AM3/14/2022 8:40 AM
DetailsStateUpdateHospital Type Change RequestActiveTo Be Terminated3/14/2022 8:40 AM
TerminationsTermination DateUpdateHospital Type Change Request 4/1/2022 12:00:00 AM3/14/2022 8:40 AM
TerminationsTermination Effective DateUpdateHospital Type Change Request 4/1/2022 12:00:00 AM3/14/2022 8:40 AM
TerminationsTermination ReasonUpdateHospital Type Change Request Change of covered entity type3/14/2022 8:40 AM
Medicaid BillingNPI: NumberDeleteRecertification1124405592 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1255540647 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1265495394 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1285032128 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1326446253 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1336526276 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1366444507 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1417334350 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1467850149 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1497132336 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1548648272 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1689015489 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1770960130 (PA) 9/1/2021 9:16 AM
Medicaid BillingNPI: NumberDeleteRecertification1972652063 (PA) 9/1/2021 9:16 AM
DetailsLast Recertification DateUpdateRecertification8/17/2020 2:03:36 PM9/1/2021 9:16:03 AM9/1/2021 9:16 AM
AddressesShipping AddressDeleteChange RequestCommunity Medical Center 1800 Mulberry St Scranton, PA 18510 4/18/2021 2:31 PM
AddressesShipping AddressInsertChange Request Community Medical Center DBA Geisinger Phy Scranton 1800 Mulberry St Scranton, PA 185104/18/2021 2:31 PM
AddressesShipping AddressInsertChange Request Community Medical Center 1800 Mulberry St Scranton, PA 185104/6/2021 11:13 AM
AddressesShipping AddressInsertChange Request Community Medical Center 316 Colfax Ave Scranton, PA 185102/24/2021 6:48 AM
ContactsPrimary ContactUpdateChange RequestKrah, Matthew Brandon 340B Program Manager Geisinger 5702140379Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 570214103512/21/2020 12:48 PM
ContactsPrimary ContactUpdateProfile Change RequestKrah, Matthew Brandon 340B Senior Pharmacy Analyst Geisinger 5702140379Krah, Matthew Brandon 340B Program Manager Geisinger 570214037910/9/2020 3:27 PM
AddressesShipping AddressInsertChange Request SAFECOR 4060 BUSINESS PARK DR STE B COLOMBUS, OH 432049/14/2020 8:09 AM
Medicaid BillingNPI: NumberInsertRecertification 11244055928/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 12555406478/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 12654953948/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 12850321288/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 13264462538/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 13365262768/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 13664445078/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 14173343508/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 14678501498/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 14971323368/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 15486482728/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 16890154898/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 17709601308/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
Medicaid BillingNPI: NumberInsertRecertification 19726520638/17/2020 2:03 PM
Medicaid BillingNPI: StateInsertRecertification PA8/17/2020 2:03 PM
DetailsLast Recertification DateUpdateRecertification8/22/2019 1:16:24 PM8/17/2020 2:03:36 PM8/17/2020 2:03 PM
AddressesShipping AddressInsertChange Request GSS Distribution Center 212 Industrial Park Rd Elysburg, PA 178248/17/2020 2:01 PM
Medicaid BillingMedicaid: NumberDeleteChange Request100745676002 (PA) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1366444507 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1255540647 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1972652063 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1265495394 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1467850149 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1689015489 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1841547338 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1770960130 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1124405592 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1336526276 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1417334350 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1548648272 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1497132336 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1326446253 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberDeleteChange Request1285032128 ( ) 8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 11244055928/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 12555406478/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 12654953948/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 12850321288/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 13264462538/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 13365262768/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 13664445078/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 14173343508/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 14678501498/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 14971323368/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 15486482728/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 16890154898/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 17709601308/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
Medicaid BillingNPI: NumberInsertChange Request 19726520638/17/2020 2:01 PM
Medicaid BillingNPI: StateInsertChange Request PA8/17/2020 2:01 PM
DetailsLast Recertification DateUpdateRecertification 8/22/2019 1:16:24 PM8/22/2019 1:16 PM
Medicaid BillingMedicaid: NumberUpdateChange Request10074567600310074567600367/30/2019 7:35 AM
DetailsStateUpdate ApprovedActive7/1/2019 12:05 AM
AddressesShipping AddressInsertChange Request Community Medical Center Pharmacy 1822 Mulberry St Scranton, PA 185106/3/2019 6:42 AM
ContactsSigned ByInsertNew Registration Beer, Ron Chief Admiistrative Officer Geisinger Wyoming Valley Medical Center 57080853804/16/2019 12:39 PM
Details340B IDUpdateNew Registration RRC390001-004/16/2019 12:39 PM
DatesParticipating Approval DateUpdateNew Registration 4/16/2019 12:39:21 PM4/16/2019 12:39 PM
DetailsStateUpdateNew RegistrationPendingApproved4/16/2019 12:39 PM
DatesSigned By DateUpdateNew Registration 4/10/2019 12:23:11 PM4/16/2019 12:39 PM
DatesStart DateUpdateNew Registration 7/1/2019 12:00:00 AM4/16/2019 12:39 PM
AddressesMain AddressInsertNew Registration  1800 MULBERRY STREET SCRANTON, PA 185104/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600064/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600054/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600234/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600204/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600314/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 1007456760024/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600324/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 1007456760034/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600374/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600334/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600354/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600344/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600384/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False4/4/2019 11:47 AM
Medicaid BillingMedicaid: NumberInsertNew Registration 10074567600394/4/2019 11:47 AM
Medicaid BillingMedicaid: StateInsertNew Registration PA4/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 13664445074/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 12555406474/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 19726520634/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 12654953944/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 14678501494/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 16890154894/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 18415473384/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 17709601304/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 11244055924/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 13365262764/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 14173343504/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 15486482724/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 14971323364/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 13264462534/4/2019 11:47 AM
Medicaid BillingNPI: NumberInsertNew Registration 12850321284/4/2019 11:47 AM
ContactsAuthorizing OfficialInsertNew Registration Beer, Ron Chief Admiistrative Officer Geisinger Wyoming Valley Medical Center 57080853804/4/2019 11:47 AM
ContactsPrimary ContactInsertNew Registration Krah, Matthew Brandon 340B Senior Pharmacy Analyst Geisinger 57021403794/4/2019 11:47 AM
DetailsLast Recertification DateInsertNew Registration  4/4/2019 11:47 AM
DetailsGrant NumberInsertNew Registration  4/4/2019 11:47 AM
Details340B IDInsertNew Registration  4/4/2019 11:47 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/4/2019 11:47 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/4/2019 11:47 AM
DetailsMedicare Provider NumberInsertNew Registration 3900014/4/2019 11:47 AM
DetailsEntity NameInsertNew Registration COMMUNITY MEDICAL CENTER4/4/2019 11:47 AM
DetailsProgram CodeInsertNew Registration RRC4/4/2019 11:47 AM
DetailsEntity SubnameInsertNew Registration  4/4/2019 11:47 AM
DatesParticipating Approval DateInsertNew Registration  4/4/2019 11:47 AM
DetailsStateInsertNew Registration Pending4/4/2019 11:47 AM
DatesRegistration DateInsertNew Registration 4/4/2019 11:47:08 AM4/4/2019 11:47 AM
DatesSigned By DateInsertNew Registration  4/4/2019 11:47 AM
DatesStart DateInsertNew Registration  4/4/2019 11:47 AM
TerminationsTermination CommentsInsertNew Registration  4/4/2019 11:47 AM
TerminationsTermination DateInsertNew Registration  4/4/2019 11:47 AM
TerminationsTermination Effective DateInsertNew Registration  4/4/2019 11:47 AM
TerminationsTermination ReasonInsertNew Registration  4/4/2019 11:47 AM