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GEISINGER SPECIALTY PHARMACY
RRC390001-00 COMMUNITY MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390001-00
Entity Address
1800 MULBERRY STREET
SCRANTON, PA 18510
Medicare Provider Number
390001
Participating Start Date
1/1/2024
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
GEISINGER SPECIALTY PHARMACY
Pharmacy Address
620 BALTIMORE DR
STE 100
WILKES BARRE, PA 18702
Pharmacy Comments
Contract Details
Approval Date
4/16/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
Geisinger Health
Ann Marie C Petrochko, Director Pharmacy Services
(570) 808-3339
Signed By Date
4/5/2019
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