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GIANT PHARMACY #6055
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
GIANT PHARMACY #6055
Pharmacy Address
325 W. FREEDOM AVE, STE 150
BURNHAM, PA 17009
Pharmacy Comments
Contract Details
Approval Date
1/17/2022
Contract Begin Date
4/1/2022
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
The Giant Company
Nick Koch, Regional Pharmacy Manager
(484) 655-0805
Signed By Date
1/17/2022
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