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WAL-MART PHARMACY 10-1623
DSH390270 GEISINGER WYOMING VALLEY MED CTR
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Covered Entity Details
Entity Name
GEISINGER WYOMING VALLEY MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390270
Entity Address
1000 EAST MOUNTAIN BLVD
WILKES BARRE, PA 18711
Medicare Provider Number
390270
Participating Start Date
7/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1623
Pharmacy Address
2150 WILKES-BARRE TWP MKTPL
WILKES-BARRE, PA 18702
Pharmacy Comments
Contract Details
Approval Date
10/3/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/3/2019
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