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GEISINGER PHARMACY
HV46012A Geisinger Clinic
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Covered Entity Details
Entity Name
Geisinger Clinic
Subdivision Name
Geisinger Clinic RW Part C
Type
Ryan White Part C
340B ID
HV46012A
Entity Address
400 Highland Ave
Lewistown, PA 17044
Grant Number
H76HA46012-02-00
Participating Start Date
7/1/2024
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GEISINGER PHARMACY
Pharmacy Address
126 MARKET WAY
MOUNT POCONO, PA 18344
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Anthony Evans, VP Pharmacy CPO
(570) 271-6192
Contract Pharmacy Representative
Geisinger
Jenny D Plummer, Director Retail and Mail Order Pharmacy
(814) 231-4571
Signed By Date
1/13/2025
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