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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390048 GEISINGER LEWISTOWN HOSPITAL
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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 # 01684
127 SOUTH POTTER STREET
BELLEFONTE, PA 16823
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
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