Contract Pharmacy Details

PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390048 GEISINGER LEWISTOWN HOSPITAL

Covered Entity Details

Entity Name

GEISINGER LEWISTOWN HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH390048

Entity Address

400 HIGHLAND AVENUE
LEWISTOWN, PA 17044

Medicare Provider Number

390048

Participating Start Date

1/1/2025

Last Recertification Date

Pharmacy Details

Pharmacy Name

PENNSYLVANIA CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 01916
1101 NORTH ATHERTON STREET
STATE COLLEGE, PA 16803

Pharmacy Comments

Contract Details

Approval Date

12/10/2024

Contract Begin Date

1/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael Anthony Evans, VP Pharmacy CPO
(570) 271-6192

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2024

340B Drug Pricing Program Database