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DSH390270AW GEISINGER WYOMING VALLEY MED CTR (Active)
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Main Details
Name
GEISINGER WYOMING VALLEY MED CTR
Subdivision Name
XR Imaging Dallas
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390270AW
Medicare Provider Number
390270
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/3/2018
Last Recertification Date
8/27/2024
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
114 Lt.Michael Cleary Dr
Dallas, PA 18612
Billing Address
Geisinger Wyoming Valley Medical Center
1000 East Mountain Blvd
Wilkes Barre, PA 18711
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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