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PERFORMSPECIALTY, LLC
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
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
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kirk E Thomas, Chief Administrative Officer
(717) 242-7102
Contract Pharmacy Representative
PerformSpecialty
Dino M Martino, Executive Director
(407) 581-9662
Signed By Date
10/15/2020
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