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PENNSYLVANIA CVS PHARMACY, L.L.C.
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
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02262
5674 ROUTE 115
BLAKESLEE, PA 18610
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/16/2018
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