340B Drug Pricing Program Database


DSH390001 COMMUNITY MEDICAL CENTER (Terminated) - information as of 5/13/2025 11:00:51 PM

Main Details
COMMUNITY MEDICAL CENTER
Disproportionate Share Hospital
Yes
DSH390001
390001


Additional Details
Terminated
3/11/2022
4/1/2022
3/14/2022
9/3/2023

1/1/2024
Change of covered entity type

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 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
PA1007456760006,1007456760005,1007456760023,1007456760020,1007456760031,1007456760032,1007456760036,1007456760037,1007456760033,1007456760035,1007456760039,1007456760042,10074567600401124405592,1265495394,1285032128,1336526276,1366444507,1417334350,1467850149,1548648272,1770960130,1972652063,1306439856,1245823764
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 INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201003/14/202204/01/2022 01/01/202401/01/2024
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884903/14/202204/01/2022 01/01/202401/01/2024
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750203/14/202204/01/2022 01/01/202401/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349203/14/202204/01/2022 01/01/202401/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282203/14/202204/01/2022 01/01/202401/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624103/14/202204/01/2022 01/01/202401/01/2024
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607503/14/202204/01/2022 01/01/202401/01/2024
Contract DetailADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101 		ORLANDOFL3280903/14/202204/01/2022 01/01/202401/01/2024
Contract DetailBIOPLUS SPECIALTY PHARMACY, INC3200 LAKE EMMA RD UNIT 1000
LAKE MARYFL3274603/14/202204/01/2022 06/15/202210/11/2022
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361403/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005603/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621903/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175703/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808303/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700403/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761703/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813303/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237403/14/202204/01/2022 01/01/202401/01/2024
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/13/202307/01/2023 01/01/202401/01/2024
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/13/202307/01/2023 01/01/202401/01/2024
Contract DetailDEPIETRO'S PHARMACY617 3RD ST
DUNMOREPA18512-284903/14/202204/01/2022 01/01/202401/01/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607504/12/202207/01/2022 01/01/202401/01/2024
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801604/12/202207/01/2022 01/01/202401/01/2024
Contract DetailGEISINGER HOME INFUSION SVCS44 WOODBINE LN
DANVILLEPA17821-802003/14/202204/01/2022 01/01/202401/01/2024
Contract DetailGEISINGER HOME INFUSION SVCS.GEISINGER PHARMACY, LLC 428 WINDMERE DR
STATE COLLEGEPA1680103/14/202204/01/2022 01/01/202401/01/2024
Contract DetailGEISINGER MAIL ORDER PHARMACY210 INDUSTRIAL PARK ROAD
ELYSBURGPA17824-977003/14/202204/01/2022 01/01/202401/01/2024
Contract DetailGEISINGER PHARMACY531 MT PLEASANT DR
SCRANTONPA18503-198703/14/202204/01/2022 01/01/202401/01/2024
Contract DetailGEISINGER SPECIALTY PHARMACY620 BALTIMORE DR STE 100
WILKES BARREPA1870203/14/202204/01/2022 01/01/202404/02/2024
Contract DetailGIANT PHARMACY18331 LEAMAN FARM ROAD
GERMANTOWNMD2087403/14/202204/01/2022 01/01/202401/01/2024
Contract DetailGIANT PHARMACY #63161550 N MAIN ST
DICKSON CITYPA1844703/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01597 101 NORTH STATE STREET
CLARKS SUMMITPA1841103/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01587 202 4TH STREET
HONESDALEPA1843103/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00053 58 WELWOOD AVE
HAWLEYPA1842803/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01593 110 GREEN RIDGE STREET
SCRANTONPA1850903/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00748 657 HAMLIN HWY.
LAKE ARIELPA1843603/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 00558 1008 SOUTH MAIN STREET
SCRANTONPA1850403/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01611 1101 MOOSIC ST.
SCRANTONPA1850503/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01615 1600 MAIN ST.
DICKSON CITYPA1851903/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01612 347-349 BLAKELY STREET
DUNMOREPA1851203/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 06790 509 DAVIS STREET
SCRANTONPA1850503/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01617 50 BRIDGE STREET
TUNKHANNOCKPA1865703/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01600 88 BROOKLYN ST.
CARBONDALEPA1840703/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.DBA: CVS/PHARMACY # 01188 101 S. MAIN ST.
OLD FORGEPA1851803/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPENNSYLVANIA CVS PHARMACY, L.L.C.CVS PHARMACY # 16806 1140 COMMERCE BLVD
DICKSON CITYPA1851903/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPERFORMSPECIALTY, LLC2416 LAKE ORANGE DR. STE 190
ORLANDOFL3283703/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514603/14/202204/01/2022 01/01/202401/01/2024
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523303/14/202204/01/2022 01/01/202401/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3775 500 NORTH MAIN AVENUE
SCRANTONPA1850404/12/202207/01/2022 01/01/202401/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #3470 580 CARBONDALE ROAD
SCOTT TOWNSHIPPA1844704/12/202207/01/2022 01/01/202401/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1426 1650 MAIN STREET
OLYPHANTPA1844704/12/202207/01/2022 01/01/202401/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #726 1080 S WASHINGTON AVENUE
SCRANTONPA1850504/12/202207/01/2022 01/01/202401/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #7878 1050 NORTHERN BLVD
CLARKS SUMMITPA1841104/12/202207/01/2022 01/01/202401/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1021 401-403 SOUTH MAIN STREET
OLD FORGEPA1851804/12/202207/01/2022 01/01/202401/01/2024
Contract DetailRITE AID OF PENNSYLVANIA, LLCRITE AID #1180 217 SOUTH BLAKELY STREET
DUNMOREPA1851204/12/202207/01/2022 01/01/202401/01/2024
Contract DetailTHE PRESCRIPTION CENTER310 ADAMS AVE
SCRANTONPA1850303/14/202204/01/2022 01/01/202401/01/2024
Contract DetailTHRIFT DRUG, INC.RITE AID #11069 1777 NORTH KEYSER AVENUE
SCRANTONPA1850804/12/202207/01/2022 01/01/202401/01/2024
Contract DetailWAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738603/14/202204/01/2022 08/14/202210/11/2022
Contract DetailWAL-MART PHARMACY 10-1884900 COMMERCE BLVD
DICKSON CITYPA1851903/14/202204/01/2022 08/14/202210/11/2022
Contract DetailWAL-MART PHARMACY 10-2024808 HUNTER HWY
TUNKHANNOCKPA1865703/14/202204/01/2022 08/14/202210/11/2022
Contract DetailWAL-MART PHARMACY 10-2480723A OLD WILLOW AVE
HONESDALEPA1843103/14/202204/01/2022 08/14/202210/11/2022
Contract DetailWAL-MART PHARMACY 10-53152354 COMMERCE PARK DR.
ORLANDOFL3281903/14/202204/01/2022 08/14/202210/11/2022
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527503/14/202204/01/2022 01/01/202401/01/2024
Contract DetailWALMART PHARMACY 10-42761325 MAIN ST.
TAYLORPA1851703/14/202204/01/2022 08/14/202210/11/2022
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH390001AChildDSHCOMMUNITY MEDICAL CENTERCOMMUNITY MEDICAL CENTER - Gastroenterology ACC Olive St.3 WEST OLIVE STREETSCRANTONPATerminated
DSH390001BChildDSHCOMMUNITY MEDICAL CENTERCOMMUNITY MEDICAL CENTER - Neurology W. Olive St3 WEST OLIVE STREETSCRANTONPATerminated
DSH390001CChildDSHCOMMUNITY MEDICAL CENTERCOMMUNITY MEDICAL CENTER - Neurophysiology W. Olive St.3 WEST OLIVE STREETSCRANTONPATerminated
DSH390001DChildDSHCOMMUNITY MEDICAL CENTERCOMMUNITY MEDICAL CENTER - Endocrinology W Olive St3 WEST OLIVE STREETSCRANTONPATerminated
DSH390001EChildDSHCOMMUNITY MEDICAL CENTERCOMMUNITY MEDICAL CENTER - Urogyn ACC Olive St3 WEST OLIVE STREETSCRANTONPATerminated
DSH390001FChildDSHCOMMUNITY MEDICAL CENTERCOMMUNITY MEDICAL CENTER - Dermatology ACC Olive St3 WEST OLIVE STREETSCRANTONPATerminated
DSH390001GChildDSHCOMMUNITY MEDICAL CENTERCOMMUNITY MEDICAL CENTER - Otolaryngology ACC W Olive St3 WEST OLIVE STREETSCRANTONPATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated1/1/2024 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateHospital Type Change Request 1/1/2024 12:00:00 AM11/27/2023 12:51 PM
DetailsStateUpdateHospital Type Change RequestActiveTo Be Terminated11/27/2023 12:51 PM
TerminationsTermination DateUpdateHospital Type Change Request 1/1/2024 12:00:00 AM11/27/2023 12:51 PM
TerminationsTermination Effective DateUpdateHospital Type Change Request 1/1/2024 12:00:00 AM11/27/2023 12:51 PM
TerminationsTermination ReasonUpdateHospital Type Change Request Change of covered entity type11/27/2023 12:51 PM
Medicaid BillingMedicaid: NumberDeleteChange Request1007456760038 (PA) 9/6/2023 9:27 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/6/2023 9:27 PM
Medicaid BillingMedicaid: NumberInsertChange Request 10074567600409/6/2023 9:27 PM
Medicaid BillingMedicaid: StateInsertChange Request PA9/6/2023 9:27 PM
Medicaid BillingNPI: NumberDeleteChange Request1255540647 (PA) 9/6/2023 9:27 PM
Medicaid BillingNPI: NumberDeleteChange Request1326446253 (PA) 9/6/2023 9:27 PM
Medicaid BillingNPI: NumberDeleteChange Request1689015489 (PA) 9/6/2023 9:27 PM
DetailsLast Recertification DateUpdateRecertification8/26/2022 10:42:35 AM9/3/2023 10:22:58 AM9/3/2023 10:22 AM
DatesLast Date That 340B Drugs PurchasedUpdateOPA Cancel Termination Request12/21/2022 12:00:00 AM 12/28/2022 9:51 AM
DetailsStateUpdateOPA Cancel Termination RequestTo Be TerminatedActive12/28/2022 9:51 AM
TerminationsTermination CommentsUpdateOPA Cancel Termination RequestDSH percentage fell below 11.75%. The cost report was filed at the end of business on 12/21/22. All 340B orders were submitted prior to the cost report being filed. 12/28/2022 9:51 AM
TerminationsTermination DateUpdateOPA Cancel Termination Request1/1/2023 12:00:00 AM 12/28/2022 9:51 AM
TerminationsTermination Effective DateUpdateOPA Cancel Termination Request12/21/2022 12:00:00 AM 12/28/2022 9:51 AM
TerminationsTermination ReasonUpdateOPA Cancel Termination RequestDSH percentage below statutory minimum 12/28/2022 9:51 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 12/21/2022 12:00:00 AM12/22/2022 4:51 PM
DetailsStateUpdateTermination RequestActiveTo Be Terminated12/22/2022 4:51 PM
TerminationsTermination CommentsUpdateTermination Request DSH percentage fell below 11.75%. The cost report was filed at the end of business on 12/21/22. All 340B orders were submitted prior to the cost report being filed.12/22/2022 4:51 PM
TerminationsTermination DateUpdateTermination Request 1/1/2023 12:00:00 AM12/22/2022 4:51 PM
TerminationsTermination Effective DateUpdateTermination Request 12/21/2022 12:00:00 AM12/22/2022 4:51 PM
TerminationsTermination ReasonUpdateTermination Request DSH percentage below statutory minimum12/22/2022 4:51 PM
Medicaid BillingNPI: NumberInsertChange Request 124582376412/9/2022 1:37 PM
Medicaid BillingNPI: StateInsertChange Request PA12/9/2022 1:37 PM
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 8/26/2022 10:42:35 AM8/26/2022 10:42 AM
DetailsStateUpdate ApprovedActive4/1/2022 12:01 AM
Details340B IDUpdateHospital Type Change Request DSH3900013/14/2022 8:40 AM
DatesParticipating Approval DateUpdateHospital Type Change Request 3/14/2022 8:40:13 AM3/14/2022 8:40 AM
DetailsStateUpdateHospital Type Change RequestPendingApproved3/14/2022 8:40 AM
DatesSigned By DateUpdateHospital Type Change Request 3/12/2022 9:12:20 AM3/14/2022 8:40 AM
DatesStart DateUpdateHospital Type Change Request 4/1/2022 12:00:00 AM3/14/2022 8:40 AM
AddressesMain AddressInsertHospital Type Change Request  1800 MULBERRY STREET SCRANTON, PA 185103/11/2022 2:22 PM
AddressesShipping AddressInsertHospital Type Change Request Community Medical Center Pharmacy 1822 Mulberry St Scranton, PA 185103/11/2022 2:22 PM
AddressesShipping AddressInsertHospital Type Change Request GSS Distribution Center 212 Industrial Park Rd Elysburg, PA 178243/11/2022 2:22 PM
AddressesShipping AddressInsertHospital Type Change Request SAFECOR 4060 BUSINESS PARK DR STE B COLOMBUS, OH 432043/11/2022 2:22 PM
AddressesShipping AddressInsertHospital Type Change Request Community Medical Center 316 Colfax Ave Scranton, PA 185103/11/2022 2:22 PM
AddressesShipping AddressInsertHospital Type Change Request Community Medical Center DBA Geisinger Phy Scranton 1800 Mulberry St Scranton, PA 185103/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600063/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600053/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600233/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600203/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600313/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600323/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600363/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600373/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600333/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600353/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600383/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600393/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingMedicaid: Is PrimaryInsertHospital Type Change Request False3/11/2022 2:22 PM
Medicaid BillingMedicaid: NumberInsertHospital Type Change Request 10074567600423/11/2022 2:22 PM
Medicaid BillingMedicaid: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 11244055923/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 12555406473/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 12654953943/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 12850321283/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 13264462533/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 13365262763/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 13664445073/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 14173343503/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 14678501493/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 15486482723/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 16890154893/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 17709601303/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 19726520633/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
Medicaid BillingNPI: NumberInsertHospital Type Change Request 13064398563/11/2022 2:22 PM
Medicaid BillingNPI: StateInsertHospital Type Change Request PA3/11/2022 2:22 PM
ContactsAuthorizing OfficialInsertHospital Type Change Request Beer, Ron Chief Admiistrative Officer Geisinger Wyoming Valley Medical Center 57080853803/11/2022 2:22 PM
ContactsSigned ByInsertHospital Type Change Request Beer, Ron Chief Admiistrative Officer Geisinger Wyoming Valley Medical Center 57080853803/11/2022 2:22 PM
ContactsPrimary ContactInsertHospital Type Change Request Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 57021410353/11/2022 2:22 PM
DetailsAssistance Received From DateInsertHospital Type Change Request  3/11/2022 2:22 PM
DetailsAssistance Received To DateInsertHospital Type Change Request  3/11/2022 2:22 PM
DetailsLast Recertification DateInsertHospital Type Change Request  3/11/2022 2:22 PM
DetailsGrant NumberInsertHospital Type Change Request  3/11/2022 2:22 PM
Details340B IDInsertHospital Type Change Request  3/11/2022 2:22 PM
DetailsIs Authorizing Official EHB DataInsertHospital Type Change Request  3/11/2022 2:22 PM
DatesLast Date That 340B Drugs PurchasedInsertHospital Type Change Request  3/11/2022 2:22 PM
DetailsMedicare Provider NumberInsertHospital Type Change Request 3900013/11/2022 2:22 PM
DetailsEntity NameInsertHospital Type Change Request COMMUNITY MEDICAL CENTER3/11/2022 2:22 PM
DetailsNOFO NumberInsertHospital Type Change Request  3/11/2022 2:22 PM
DetailsProgram CodeInsertHospital Type Change Request DSH3/11/2022 2:22 PM
DetailsEntity SubnameInsertHospital Type Change Request  3/11/2022 2:22 PM
DatesParticipating Approval DateInsertHospital Type Change Request  3/11/2022 2:22 PM
DetailsStateInsertHospital Type Change Request Pending3/11/2022 2:22 PM
DatesRegistration DateInsertHospital Type Change Request 3/11/2022 2:22:36 PM3/11/2022 2:22 PM
DatesSigned By DateInsertHospital Type Change Request  3/11/2022 2:22 PM
DatesStart DateInsertHospital Type Change Request  3/11/2022 2:22 PM
TerminationsTermination CommentsInsertHospital Type Change Request  3/11/2022 2:22 PM
TerminationsTermination DateInsertHospital Type Change Request  3/11/2022 2:22 PM
TerminationsTermination Effective DateInsertHospital Type Change Request  3/11/2022 2:22 PM
TerminationsTermination ReasonInsertHospital Type Change Request  3/11/2022 2:22 PM