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GEISINGER SPECIALTY PHARMACY
SCH390048-00 GEISINGER LEWISTOWN HOSPITAL
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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
GEISINGER SPECIALTY PHARMACY
Pharmacy Address
620 BALTIMORE DR
STE 100
WILKES BARRE, PA 18702
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
Geisinger Health
Ann Marie C Petrochko, Director Pharmacy Services
(570) 808-3339
Signed By Date
4/12/2022
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