Contract Pharmacy Details

PROCARE PHARMACY, L.L.C.
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

PROCARE PHARMACY, L.L.C.

Pharmacy Address

DBA CVS/PHARMACY #2923
3250 HARDEN ST. EXT. SUITE #300
COLUMBIA, SC 29203

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

1/1/2025
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

4/12/2022

340B Drug Pricing Program Database