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DSH390270BG GEISINGER WYOMING VALLEY MED CTR (Terminated)
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Main Details
Name
GEISINGER WYOMING VALLEY MED CTR
Subdivision Name
ORTHOPEDICS 1155 E MTN BLVD WB - ORTHOPEDICS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390270BG
Medicare Provider Number
390270
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/12/2021
Participating Start Date
10/1/2021
Participating Approval Date
8/18/2021
Last Recertification Date
9/3/2023
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
1155 E MOUNTAIN BLVD
WILKES BARRE, PA 18702
Billing Address
GEISINGER WYOMING VALLEY MEDICAL CENTER
1000 EAST MOUNTAIN BLVD
WILKES BARRE, PA 18711
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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