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RITE AID OF NEW JERSEY, INC.
CHC00064-04 ODA PRIMARY HEALTH CARE CENTER, INC.
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Covered Entity Details
Entity Name
ODA PRIMARY HEALTH CARE CENTER, INC.
Subdivision Name
ODA Monticello Primary Health Care Center
Type
HRSA-Funded Health Center
340B ID
CHC00064-04
Entity Address
60 Jefferson Street Suite 1
Monticello, NY 12701-1131
Grant Number
H80CS00064
Participating Start Date
7/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
RITE AID OF NEW JERSEY, INC.
Pharmacy Address
RITE AID #149
1097 BROADWAY
BAYONNE, NJ 07002
Pharmacy Comments
Contract Details
Approval Date
7/9/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/18/2024
OPA Terminated due to audit finding
Contacts
Covered Entity Signing Official
Joseph Deutsch, Chief Executive Officer
(718) 260-4600 Ext: 301
Contract Pharmacy Representative
Rite Aide
Lisa Foster, Manager Pharmaceutical Replenishment Program
(717) 214-2518
Signed By Date
7/9/2019
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