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GIANT PHARMACY #6287
DSH390006 GEISINGER MEDICAL CENTER
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Covered Entity Details
Entity Name
GEISINGER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390006
Entity Address
100 NORTH ACADEMY AVENUE
DANVILLE, PA 17822
Medicare Provider Number
390006
Participating Start Date
4/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
GIANT PHARMACY #6287
Pharmacy Address
1000 SCOTT TOWN CTR
BLOOMSBURG, PA 17815
Pharmacy Comments
Contract Details
Approval Date
1/17/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Megan M Brosious, Chief Administrative Officer
(570) 271-8892
Contract Pharmacy Representative
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
1/17/2022
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