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SCH390048-09 GEISINGER LEWISTOWN HOSPITAL (Terminated)
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Main Details
Name
GEISINGER LEWISTOWN HOSPITAL
Subdivision Name
GEISINGER LEWISTOWN HOSPITAL ENDO - Endo GECL
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH390048-09
Medicare Provider Number
390048
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2024
Participating Start Date
4/1/2024
Participating Approval Date
3/6/2024
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 17044-1369
Billing Address
Geisinger Lewistown Hospital
400 Highland Ave
Lewistown, PA 17044
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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