Contract Pharmacy Details

PENNSYLVANIA CVS PHARMACY, L.L.C.
RRC390001-01 COMMUNITY MEDICAL CENTER

Covered Entity Details

Entity Name

COMMUNITY MEDICAL CENTER

Subdivision Name

GEISINGER COMMUNITY MEDICAL CENTER - GEN DIAGNOSTIC RAD VMT

Type

Rural Referral Center

340B ID

RRC390001-01

Entity Address

435 SCRANTON CARBONDALE HIGHWAY
SCRANTON, PA 18508-1115

Medicare Provider Number

390001

Outpatient Facility Provider Number

Participating Start Date

7/1/2019

Last Recertification Date

9/1/2021

Entity Termination Date

4/1/2022

Pharmacy Details

Pharmacy Name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01615
1600 MAIN ST.
DICKSON CITY, PA 18519

Pharmacy Comments

Contract Details

Approval Date

7/22/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/22/2021

340B Drug Pricing Program Database