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SCH390048-01 GEISINGER LEWISTOWN HOSPITAL (Terminated)
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Main Details
Name
GEISINGER LEWISTOWN HOSPITAL
Subdivision Name
GEISINGER LEWISTOWN HOSPITAL - Rad Oncology Tech
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH390048-01
Medicare Provider Number
390048
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2022
Participating Start Date
4/14/2022
Participating Approval Date
4/14/2022
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
211 3RD ST
LEWISTOWN, PA 17044-1314
Billing Address
Geisinger Lewistown Hospital
400 Highland Ave
Lewistown, PA 17044
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (1/1/2019) until terminated effective date: (07/01/2021), Reinstatement effective date: (04/14/2022)
04/14/2022
May 2025
May 2025
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