Covered Entity Details

SCH390048-06 GEISINGER LEWISTOWN HOSPITAL (Terminated) - information as of 6/27/2025 5:57:56 AM

Main Details

Name

GEISINGER LEWISTOWN HOSPITAL

Subdivision Name

Geisinger Lewistown Hospital - Infectious Disease ACC

Type

Sole Community Hospital

Rural

Yes

340B ID

SCH390048-06

Medicare Provider Number

390048

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/1/2022

Participating Start Date

10/1/2022

Participating Approval Date

7/6/2022

Last Recertification Date

8/16/2024

Termination Date
Termination Reason

1/1/2025
Change of covered entity type

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

310 Electric Ave
Lewistown, PA 17044

Billing Address

Geisinger Lewistown Hospital
400 Highland Ave
Lewistown, PA 17044

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
PA	1007506760004,1007506760023,1007506760041,1007506760043,1007506760045,1007506760046,1007506760050	1861545683,1639560550,1609263946,1497338313,1750778981,1801531322,1841970746

Shipping Addresses

Shipping Address 1

Geisinger Lewistown Hospital
400 Highland Ave
Lewistown, PA 17044

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
SCH390048-01	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - Rad Oncology Tech	211 3RD ST	LEWISTOWN	PA	Terminated
SCH390048-02	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - Gen Diagnostics RAD JVMC	27 CJEMS LANE	MIFFLINTOWN	PA	Terminated
SCH390048-03	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - Cat Scanner JVMC Mobile	27 CJEMS LANE	MIFFLINTOWN	PA	Terminated
SCH390048-04	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - Ultrasound JVMC mobile	27 CJEMS LANE	MIFFLINTOWN	PA	Terminated
SCH390048-05	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - MRI JVMC Mobile	27 CJEMS LANE	MIFFLINTOWN	PA	Terminated
SCH390048-06	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	Geisinger Lewistown Hospital - Infectious Disease ACC	310 Electric Ave	Lewistown	PA	Terminated
SCH390048-07	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	Geisinger Lewistown Hospital - Gastro Electric Ave	310 Electric Ave	Lewistown	PA	Terminated
SCH390048-08	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - CT Imaging MIfflintown	27 CJEMS LANE	MIFFLINTOWN	PA	Terminated
SCH390048-09	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL ENDO - Endo GECL	310 ELECTRIC AVE	LEWISTOWN	PA	Terminated
SCH390048-10	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - OR OSSC	132 ABIGAIL LN	PORT MATILDA	PA	Terminated
SCH390048-11	Child	SCH	GEISINGER LEWISTOWN HOSPITAL	GEISINGER LEWISTOWN HOSPITAL - MR Imaging Mifflintown	27 CJEMS LANE	MIFFLINTOWN	PA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	1/1/2025 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	12/10/2024 11:36 AM
Details	State	Update	Hospital Type Change Request	Active	To Be Terminated	12/10/2024 11:36 AM
Terminations	Termination Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	12/10/2024 11:36 AM
Terminations	Termination Effective Date	Update	Hospital Type Change Request		1/1/2025 12:00:00 AM	12/10/2024 11:36 AM
Terminations	Termination Reason	Update	Hospital Type Change Request		Change of covered entity type	12/10/2024 11:36 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007506760008 (PA)		8/16/2024 7:03 AM
Medicaid Billing	Medicaid: Number	Delete	Recertification	1007506760042 (PA)		8/16/2024 7:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/16/2024 7:03 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007506760046	8/16/2024 7:03 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/16/2024 7:03 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	8/16/2024 7:03 AM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1007506760050	8/16/2024 7:03 AM
Medicaid Billing	Medicaid: State	Insert	Recertification		PA	8/16/2024 7:03 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1831242114 (PA)		8/16/2024 7:03 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1558486928 (PA)		8/16/2024 7:03 AM
Medicaid Billing	NPI: Number	Delete	Recertification	1689061921 (PA)		8/16/2024 7:03 AM
Details	Last Recertification Date	Update	Recertification	9/6/2023 12:52:28 PM	8/16/2024 7:03:14 AM	8/16/2024 7:03 AM
Contacts	Authorizing Official	Update	AO Change Request	Thomas, Kirk E Chief Administrative Officer Geisinger Lewistown Hospital 7172427102	Evans, Michael Anthony VP Pharmacy CPO Geisinger Health 5702716192	9/8/2023 1:08 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1841970746	9/6/2023 12:52 PM
Medicaid Billing	NPI: State	Insert	Recertification		PA	9/6/2023 12:52 PM
Details	Last Recertification Date	Update	Recertification		9/6/2023 12:52:28 PM	9/6/2023 12:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	6/12/2023 11:01 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1007506760045	6/12/2023 11:01 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		PA	6/12/2023 11:01 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1801531322	6/12/2023 11:01 AM
Medicaid Billing	NPI: State	Insert	Change Request		PA	6/12/2023 11:01 AM
Details	State	Update		Approved	Active	10/1/2022 12:01 AM
Contacts	Primary Contact	Update	Profile Change Request	Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 5702141035	Travelpiece, Lola 340B Program Manager Geisinger Health 5702141035	9/26/2022 9:58 AM
Contacts	Signed By	Insert	New Registration		Thomas, Kirk E Chief Administrative Officer Geisinger Lewistown Hospital 7172427102	7/6/2022 7:47 AM
Details	340B ID	Update	New Registration		SCH390048-06	7/6/2022 7:47 AM
Details	Entity Subname	Update	New Registration	Geisinger Lewistown Hospital	Geisinger Lewistown Hospital - Infectious Disease ACC	7/6/2022 7:47 AM
Dates	Participating Approval Date	Update	New Registration		7/6/2022 7:47:54 AM	7/6/2022 7:47 AM
Details	State	Update	New Registration	Pending	Approved	7/6/2022 7:47 AM
Dates	Signed By Date	Update	New Registration		7/5/2022 7:40:51 AM	7/6/2022 7:47 AM
Dates	Start Date	Update	New Registration		10/1/2022 12:00:00 AM	7/6/2022 7:47 AM
Addresses	Main Address	Insert	New Registration		310 Electric Ave Lewistown, PA 17044	7/1/2022 8:42 AM
Addresses	Billing Address	Insert	New Registration		Geisinger Lewistown Hospital 400 Highland Ave Lewistown, PA 17044	7/1/2022 8:42 AM
Addresses	Shipping Address	Insert	New Registration		Geisinger Lewistown Hospital 400 Highland Ave Lewistown, PA 17044	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007506760008	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007506760004	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007506760023	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007506760041	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007506760042	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007506760043	7/1/2022 8:42 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1831242114	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1558486928	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1861545683	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1639560550	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1609263946	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1497338313	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1689061921	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1750778981	7/1/2022 8:42 AM
Medicaid Billing	NPI: State	Insert	New Registration		PA	7/1/2022 8:42 AM
Contacts	Authorizing Official	Insert	New Registration		Thomas, Kirk E Chief Administrative Officer Geisinger Lewistown Hospital 7172427102	7/1/2022 8:42 AM
Contacts	Primary Contact	Insert	New Registration		Travelpiece, Lola 340b Analyst Supervisor Geisinger Health 5702141035	7/1/2022 8:42 AM
Details	Assistance Received From Date	Insert	New Registration			7/1/2022 8:42 AM
Details	Assistance Received To Date	Insert	New Registration			7/1/2022 8:42 AM
Details	Last Recertification Date	Insert	New Registration			7/1/2022 8:42 AM
Details	Grant Number	Insert	New Registration			7/1/2022 8:42 AM
Details	340B ID	Insert	New Registration			7/1/2022 8:42 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			7/1/2022 8:42 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			7/1/2022 8:42 AM
Details	Medicare Provider Number	Insert	New Registration		390048	7/1/2022 8:42 AM
Details	Entity Name	Insert	New Registration		GEISINGER LEWISTOWN HOSPITAL	7/1/2022 8:42 AM
Details	NOFO Number	Insert	New Registration			7/1/2022 8:42 AM
Details	Program Code	Insert	New Registration		SCH	7/1/2022 8:42 AM
Details	Entity Subname	Insert	New Registration		Geisinger Lewistown Hospital	7/1/2022 8:42 AM
Dates	Participating Approval Date	Insert	New Registration			7/1/2022 8:42 AM
Details	State	Insert	New Registration		Pending	7/1/2022 8:42 AM
Dates	Registration Date	Insert	New Registration		7/1/2022 8:42:47 AM	7/1/2022 8:42 AM
Dates	Signed By Date	Insert	New Registration			7/1/2022 8:42 AM
Dates	Start Date	Insert	New Registration			7/1/2022 8:42 AM
Terminations	Termination Comments	Insert	New Registration			7/1/2022 8:42 AM
Terminations	Termination Date	Insert	New Registration			7/1/2022 8:42 AM
Terminations	Termination Effective Date	Insert	New Registration			7/1/2022 8:42 AM
Terminations	Termination Reason	Insert	New Registration			7/1/2022 8:42 AM