Contract Pharmacy Details

PERFORMSPECIALTY, LLC
SCH390048-00 GEISINGER LEWISTOWN HOSPITAL

Covered Entity Details

Entity Name

GEISINGER LEWISTOWN HOSPITAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH390048-00

Entity Address

400 HIGHLAND AVENUE
LEWISTOWN, PA 17044

Medicare Provider Number

390048

Participating Start Date

4/14/2022

Last Recertification Date

8/16/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

PERFORMSPECIALTY, LLC

Pharmacy Address

2416 LAKE ORANGE DR.
STE 190
ORLANDO, FL 32837

Pharmacy Comments

Contract Details

Approval Date

4/14/2022

Contract Begin Date

4/14/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Kirk E Thomas, Chief Administrative Officer
(717) 242-7102

Contract Pharmacy Representative

PerformSpecialty
Dino M Martino, Executive Director
(407) 581-9662

Signed By Date

4/12/2022

340B Drug Pricing Program Database