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WAL-MART PHARMACY 10-1607
DSH390006 GEISINGER MEDICAL CENTER
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Covered Entity Details
Entity Name
GEISINGER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390006
Entity Address
100 NORTH ACADEMY AVENUE
DANVILLE, PA 17822
Medicare Provider Number
390006
Participating Start Date
4/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1607
Pharmacy Address
10180 US HWY 522 SOUTH
LEWISTOWN, PA 17044
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas P. Sokola, Chief Administrative Officer
(570) 271-8892
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2019
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