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WAL-MART CENTRAL FILL 10-2670
SCH390048-00 GEISINGER LEWISTOWN HOSPITAL
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Covered Entity Details
Entity Name
GEISINGER LEWISTOWN HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH390048-00
Entity Address
400 HIGHLAND AVENUE
LEWISTOWN, PA 17044
Medicare Provider Number
390048
Participating Start Date
4/14/2022
Last Recertification Date
8/16/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
WAL-MART CENTRAL FILL 10-2670
Pharmacy Address
608 SPRING HILL DR # 3 SUITE 300
SPRING, TX 77386
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kirk E Thomas, Chief Administrative Officer
(717) 242-7102
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/14/2019
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