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GEISINGER PHARMACY
DSH390270 GEISINGER WYOMING VALLEY MED CTR
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Covered Entity Details
Entity Name
GEISINGER WYOMING VALLEY MED CTR
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390270
Entity Address
1000 EAST MOUNTAIN BLVD
WILKES BARRE, PA 18711
Medicare Provider Number
390270
Participating Start Date
7/1/2017
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
GEISINGER PHARMACY
Pharmacy Address
175 SOUTH WILKES BARRE BLVD
WILKES BARRE, PA 18702-5040
Pharmacy Comments
Contract Details
Approval Date
4/20/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
Geisinger
Jenny D Plummer, Director Retail and Mail Order Pharmacy
(814) 231-4571
Signed By Date
4/20/2017
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