Covered Entity Details

RRC390001-18 COMMUNITY MEDICAL CENTER (Terminated) - information as of 5/20/2025 12:52:13 AM

Main Details

Name

COMMUNITY MEDICAL CENTER

Subdivision Name

Urogyn ACC W. Olive St - Urogyn

Type

Rural Referral Center

Rural

Yes

340B ID

RRC390001-18

Medicare Provider Number

390001

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

10/12/2023

Participating Start Date

1/1/2024

Participating Approval Date

11/28/2023

Last Recertification Date

Termination Date
Termination Reason

7/1/2024
Business decision by the Covered Entity

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

3 West Olive Street
Scranton, PA 18508

Billing Address

Geisinger Community Medical Center
1800 Mulberry St
Scranton, PA 18510

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	1007456760006,1007456760020,1007456760023,1007456760031,1007456760032,1007456760033,1007456760035,1007456760036,1007456760037,1007456760039,1007456760040,1007456760042,1007456760041	1124405592,1245823764,1265495394,1285032128,1306439856,1336526276,1366444507,1417334350,1467850149,1548648272,1770960130,1972652063

Shipping Addresses

Shipping Address 1

Geisinger Community Medical Center Pharmacy
1822 Mulberry St
Scranton, PA 18510

Shipping Address 2

Geisinger Community Medical Center
1800 Mulberry St
Scranton, PA 18510

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
RRC390001-01	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - GEN DIAGNOSTIC RAD VMT	435 SCRANTON CARBONDALE HIGHWAY	SCRANTON	PA	Terminated
RRC390001-02	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - CAT SCANNER VIEWMONT	435 SCRANTON CARBONDALE HIGHWAY	SCRANTON	PA	Active
RRC390001-03	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - MT PLEASANT RADIOLOGY	531 MT PLEASANT DRIVE	SCRANTON	PA	Terminated
RRC390001-04	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - OCCUP THERAPY OP VIEWMONT	423 SCRANTON-CARBONDALE HIGHWAY	SCRANTON	PA	Terminated
RRC390001-05	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - MRI VIEWMONT	435 SCRANTON CARBONDALE HIGHWAY	SCRANTON	PA	Active
RRC390001-06	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - MT PLEASANT MAMMOGRAPHY	531 MT PLEASANT DRIVE	SCRANTON	PA	Terminated
RRC390001-07	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - PHYSICAL THERAPY OP VIEWMONT	423 SCRANTON-CARBONDALE HIGHWAY	SCRANTON	PA	Terminated
RRC390001-08	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - ULTRASOUND VIEWMONT	435 SCRANTON CARBONDALE HIGHWAY	SCRANTON	PA	Terminated
RRC390001-09	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - NUCLEAR MEDICINE VMT	5 MORGAN HIGHWAY SUITE 7	SCRANTON	PA	Terminated
RRC390001-10	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - MAMMOGRAPHY VIEWMONT	435 SCRANTON CARBONDALE HIGHWAY	SCRANTON	PA	Terminated
RRC390001-11	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - MT PLEASANT ULTRASOUND	531 MT PLEASANT DRIVE	SCRANTON	PA	Terminated
RRC390001-12	Child	RRC	COMMUNITY MEDICAL CENTER	Neurology W. Olive St - Neurology	3 West Olive Street	Scranton	PA	Terminated
RRC390001-13	Child	RRC	COMMUNITY MEDICAL CENTER	Neurophysiology W. Olive St. - Neurophysiology	3 West Olive Street	Scranton	PA	Terminated
RRC390001-14	Child	RRC	COMMUNITY MEDICAL CENTER	Otolaryngology ACC W Olive St - Otolaryngology	3 West Olive Street	Scranton	PA	Terminated
RRC390001-15	Child	RRC	COMMUNITY MEDICAL CENTER	Dermatology ACC W Olive St. - Dermatology	3 West Olive St	Scranton	PA	Terminated
RRC390001-16	Child	RRC	COMMUNITY MEDICAL CENTER	Endocrinology W. Olive St. - Endocrinology	3 West Olive Street	Scranton	PA	Terminated
RRC390001-17	Child	RRC	COMMUNITY MEDICAL CENTER	Gastroenterology ACC Olive St - Gastroenterology ACC Olive St.	3 West Olive St	Scranton	PA	Terminated
RRC390001-18	Child	RRC	COMMUNITY MEDICAL CENTER	Urogyn ACC W. Olive St - Urogyn	3 West Olive Street	Scranton	PA	Terminated
RRC390001-19	Child	RRC	COMMUNITY MEDICAL CENTER	Geisinger Community Medical Center - Audiology W Olive St	3 West Olive St	Scranton	PA	Terminated
RRC390001-20	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - PET Imaging Viewmont	5 Morgan Hwy	SCRANTON	PA	Active
RRC390001-21	Child	RRC	COMMUNITY MEDICAL CENTER	Geisinger Community Medical Center - GYN OB W Olive St	3 West Olive St	Scranton	PA	Terminated
RRC390001-22	Child	RRC	COMMUNITY MEDICAL CENTER	Geisinger Community Medical Center - OB US Imaging W Olive St	3 West Olive St	Scranton	PA	Terminated
RRC390001-23	Child	RRC	COMMUNITY MEDICAL CENTER	GEISINGER COMMUNITY MEDICAL CENTER - XR Imaging Viewmont	435 SCRANTON CARBONDALE HWY	SCRANTON	PA	Active
RRC390001-26	Child	RRC	COMMUNITY MEDICAL CENTER	Geisinger Community Medical Center - GYN Urology W Olive St	3 West Olive St	Scranton	PA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	7/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		5/31/2024 12:00:00 AM	6/3/2024 4:19 PM
Details	State	Update	Termination Request	Active	To Be Terminated	6/3/2024 4:19 PM
Terminations	Termination Comments	Update	Termination Request		This location is no longer owned by Community Medical Center.	6/3/2024 4:19 PM
Terminations	Termination Date	Update	Termination Request		7/1/2024 12:00:00 AM	6/3/2024 4:19 PM
Terminations	Termination Effective Date	Update	Termination Request		5/31/2024 12:00:00 AM	6/3/2024 4:19 PM
Terminations	Termination Reason	Update	Termination Request		Business decision by the Covered Entity	6/3/2024 4:19 PM
Details	State	Update		Approved	Active	1/1/2024 12:01 AM
Medicaid Billing	Medicaid: Number	Delete	Group Change Request	1007456760005 (PA)		12/15/2023 3:15 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	12/15/2023 3:15 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		1007456760041	12/15/2023 3:15 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		PA	12/15/2023 3:15 PM
Contacts	Signed By	Insert	New Registration		Beer, Ron Chief Admiistrative Officer Geisinger Wyoming Valley Medical Center 5708085380	11/28/2023 8:04 AM
Details	340B ID	Update	New Registration		RRC390001-18	11/28/2023 8:04 AM
Details	Entity Subname	Update	New Registration	Urogyn ACC W. Olive St	Urogyn ACC W. Olive St - Urogyn	11/28/2023 8:04 AM
Dates	Participating Approval Date	Update	New Registration		11/28/2023 8:04:53 AM	11/28/2023 8:04 AM
Details	State	Update	New Registration	Pending	Approved	11/28/2023 8:04 AM
Dates	Signed By Date	Update	New Registration		10/13/2023 3:16:54 PM	11/28/2023 8:04 AM
Dates	Start Date	Update	New Registration		1/1/2024 12:00:00 AM	11/28/2023 8:04 AM
Addresses	Main Address	Insert	New Registration		3 West Olive Street Scranton, PA 18508	10/12/2023 2:59 PM
Addresses	Billing Address	Insert	New Registration		Geisinger Community Medical Center 1800 Mulberry St Scranton, PA 18510	10/12/2023 2:59 PM
Addresses	Shipping Address	Insert	New Registration		Geisinger Community Medical Center Pharmacy 1822 Mulberry St Scranton, PA 18510	10/12/2023 2:59 PM
Addresses	Shipping Address	Insert	New Registration		Geisinger Community Medical Center 1800 Mulberry St Scranton, PA 18510	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760005	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760006	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760020	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760023	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760031	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760032	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760033	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760035	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760036	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760037	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760039	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760040	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1007456760042	10/12/2023 2:59 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1124405592	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1245823764	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1265495394	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285032128	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1306439856	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1336526276	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1366444507	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1417334350	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1467850149	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1548648272	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1770960130	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1972652063	10/12/2023 2:59 PM
Medicaid Billing	NPI: State	Insert	New Registration		PA	10/12/2023 2:59 PM
Contacts	Authorizing Official	Insert	New Registration		Beer, Ron Chief Admiistrative Officer Geisinger Wyoming Valley Medical Center 5708085380	10/12/2023 2:59 PM
Contacts	Primary Contact	Insert	New Registration		Travelpiece, Lola 340B Program Manager Geisinger Health 5702141035	10/12/2023 2:59 PM
Details	Assistance Received From Date	Insert	New Registration			10/12/2023 2:59 PM
Details	Assistance Received To Date	Insert	New Registration			10/12/2023 2:59 PM
Details	Last Recertification Date	Insert	New Registration			10/12/2023 2:59 PM
Details	Grant Number	Insert	New Registration			10/12/2023 2:59 PM
Details	340B ID	Insert	New Registration			10/12/2023 2:59 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/12/2023 2:59 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/12/2023 2:59 PM
Details	Medicare Provider Number	Insert	New Registration		390001	10/12/2023 2:59 PM
Details	Entity Name	Insert	New Registration		COMMUNITY MEDICAL CENTER	10/12/2023 2:59 PM
Details	NOFO Number	Insert	New Registration			10/12/2023 2:59 PM
Details	Program Code	Insert	New Registration		RRC	10/12/2023 2:59 PM
Details	Entity Subname	Insert	New Registration		Urogyn ACC W. Olive St	10/12/2023 2:59 PM
Dates	Participating Approval Date	Insert	New Registration			10/12/2023 2:59 PM
Details	State	Insert	New Registration		Pending	10/12/2023 2:59 PM
Dates	Registration Date	Insert	New Registration		10/12/2023 2:59:14 PM	10/12/2023 2:59 PM
Dates	Signed By Date	Insert	New Registration			10/12/2023 2:59 PM
Dates	Start Date	Insert	New Registration			10/12/2023 2:59 PM
Terminations	Termination Comments	Insert	New Registration			10/12/2023 2:59 PM
Terminations	Termination Date	Insert	New Registration			10/12/2023 2:59 PM
Terminations	Termination Effective Date	Insert	New Registration			10/12/2023 2:59 PM
Terminations	Termination Reason	Insert	New Registration			10/12/2023 2:59 PM