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RITE AID OF MARYLAND, INC.
DSH210019 TIDALHEALTH PENINSULA REGIONAL INC
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Covered Entity Details
Entity Name
TIDALHEALTH PENINSULA REGIONAL INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH210019
Entity Address
100 EAST CARROLL STREET
SALISBURY, MD 21801
Medicare Provider Number
210019
Participating Start Date
3/15/2022
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
RITE AID OF MARYLAND, INC.
Pharmacy Address
RITE AID #4920
1208 PARSONS ROAD
SALISBURY, MD 21801
Pharmacy Comments
Contract Details
Approval Date
7/2/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Bruce Ritchie, CFO
(410) 543-7298
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/2/2018
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