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DSH390270AY GEISINGER WYOMING VALLEY MED CTR (Terminated)
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Main Details
Name
GEISINGER WYOMING VALLEY MED CTR
Subdivision Name
Cat Scanner South Wilkes Barre - Cat Scanner South Wilkes Barre
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390270AY
Medicare Provider Number
390270
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/3/2018
Last Recertification Date
9/5/2023
Termination Date
Termination Reason
10/1/2024
Site closure
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
25 Church St
Wilkes Barre, PA 18765
Billing Address
Geisinger Wyoming Valley Medical Center
1000 East Mountain Drive
Wilkes Barre, PA 18711
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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