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GIANT PHARMACY #6529
DSH390256 MILTON S. HERSHEY MEDICAL CENTER
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Covered Entity Details
Entity Name
MILTON S. HERSHEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390256
Entity Address
500 UNIVERSITY DRIVE
HERSHEY, PA 17033
Medicare Provider Number
390256
Participating Start Date
4/1/2004
Last Recertification Date
9/24/2024
Pharmacy Details
Pharmacy Name
GIANT PHARMACY #6529
Pharmacy Address
4510 MARKETPLACE WAY
ENOLA, PA 17025
Pharmacy Comments
Contract Details
Approval Date
4/19/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/6/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paula Marie Tinch, CFO & EVP Finance, PSH
(717) 531-1788
Contract Pharmacy Representative
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
4/19/2021
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