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ECKERD CORPORATION
DSH390270 GEISINGER WYOMING VALLEY MED CTR
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Covered Entity Details
Entity Name
GEISINGER WYOMING VALLEY MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390270
Entity Address
1000 EAST MOUNTAIN BLVD
WILKES BARRE, PA 18711
Medicare Provider Number
390270
Participating Start Date
7/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ECKERD CORPORATION
Pharmacy Address
RITE AID #11081
556 UNION STREET
LUZERNE, PA 18709
Pharmacy Comments
Contract Details
Approval Date
4/12/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/28/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
4/12/2022
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