Contract Pharmacy Details

PERFORMSPECIALTY, LLC
DSH390270 GEISINGER WYOMING VALLEY MED CTR

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

PERFORMSPECIALTY, LLC

Pharmacy Address

2416 LAKE ORANGE DR.
STE 190
ORLANDO, FL 32837

Pharmacy Comments

Contract Details

Approval Date

10/15/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Ron Beer, Chief Admiistrative Officer
(570) 808-5380

Contract Pharmacy Representative

PerformSpecialty
Dino M Martino, Executive Director
(407) 581-9662

Signed By Date

10/15/2020

340B Drug Pricing Program Database