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CARESITE 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
CARESITE PHARMACY
Pharmacy Address
1000 E Mountain Drive
Wilkes Barre, PA 18711
Pharmacy Comments
Contract Details
Approval Date
4/20/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2017
Ownership change
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
Geisinger Health
Lori Zaleski, AVP Enterprise Pharmacy
(570) 271-7965
Signed By Date
4/20/2017
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