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PENNSYLVANIA CVS PHARMACY, L.L.C.
RRC390045-00 WILLIAMSPORT HOSPITAL & MEDICAL CTR
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Covered Entity Details
Entity Name
WILLIAMSPORT HOSPITAL & MEDICAL CTR
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390045-00
Entity Address
700 HIGH STREET
WILLIAMSPORT, PA 17701
Medicare Provider Number
390045
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01610
201 MUNCY CREEK BLVD.
MUNCY, PA 17756
Pharmacy Comments
Contract Details
Approval Date
8/9/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/3/2024
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