340B Drug Pricing Program Database
Rite Aid 6811
RRC390045-00 WILLIAMSPORT HOSPITAL & MEDICAL CTR - information as of 4/29/2025 2:30:49 AM
Covered Entity Details
Entity Name
WILLIAMSPORT HOSPITAL & MEDICAL CTR
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390045-00
Entity Address
700 HIGH STREET
WILLIAMSPORT, PA 17701
Medicare Provider Number
390045
Participating Start Date
10/1/2024
Last Recertification Date
Pharmacy Details
Pharmacy Name
Rite Aid 6811
Pharmacy Address
701 Delran Pkwy
Delran, NJ 08075
Pharmacy Comments
Contract Details
Approval Date
4/9/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roger C Yost, CFO, North-Central PA Region
(570) 321-3175
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
4/9/2025
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