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RITE AID OF NEW YORK, INC.
CH021500 MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
MOUNT VERNON NEIGHBORHOOD HEALTH CENTER, INC.
Subdivision Name
MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH021500
Entity Address
107 W 4th St
Mount Vernon, NY 10550-4002
Grant Number
H80CS00161
Participating Start Date
9/9/2005
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #2541
420 SOUTH BROADWAY
YONKERS, NY 10705
Pharmacy Comments
Contract Details
Approval Date
7/11/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/20/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Opal Dunstan, CHIEF EXECUTIVE OFFICER
(914) 699-7200 Ext: 601
Contract Pharmacy Representative
Rite Aid
Lisa Foster, Manager-Pharmacy
(717) 214-2518
Signed By Date
7/11/2019
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