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PENNSYLVANIA CVS PHARMACY, L.L.C.
CAH391300-00 GEISINGER JERSEY SHORE HOSPITAL
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Covered Entity Details
Entity Name
GEISINGER JERSEY SHORE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391300-00
Entity Address
1020 THOMPSON ST
JERSEY SHORE, PA 17740
Medicare Provider Number
391300
Participating Start Date
1/1/2011
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01681
311 BELLEFONTE AVE
LOCK HAVEN, PA 17745
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Harding Anderer, Chief Administrative Officer
(570) 398-0100
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/12/2021
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