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THE MEDICINE SHOPPE
DSH390006 GEISINGER MEDICAL CENTER
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Covered Entity Details
Entity Name
GEISINGER MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390006
Entity Address
100 NORTH ACADEMY AVENUE
DANVILLE, PA 17822
Medicare Provider Number
390006
Participating Start Date
4/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
THE MEDICINE SHOPPE
Pharmacy Address
1000 MARKET ST
MARKET ST SHOPPING CENTER
BLOOMSBURG, PA 17815
Pharmacy Comments
Contract Details
Approval Date
2/21/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Edelyn Miller, Executive VP Clinical Operations
(570) 214-8126
Contract Pharmacy Representative
Ed Derrick, Owner
(724) 866-3593
Signed By Date
1/12/2013
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