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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390048 GEISINGER LEWISTOWN HOSPITAL
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Covered Entity Details
Entity Name
GEISINGER LEWISTOWN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390048
Entity Address
400 HIGHLAND AVENUE
LEWISTOWN, PA 17044
Medicare Provider Number
390048
Participating Start Date
1/1/2025
Last Recertification Date
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
10/14/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kirk E Thomas, Chief Administrative Officer
(717) 242-7102
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2021
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