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RITE AID OF PENNSYLVANIA, LLC
FQHCLA394 Wright Center Medical Group
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Covered Entity Details
Entity Name
Wright Center Medical Group
Subdivision Name
The Wright Center for Community Health Scranton Practice
Type
Health Center Program Look-Alike
340B ID
FQHCLA394
Entity Address
501 S Washington Ave
1000
Scranton, PA 18505-3814
Grant Number
LALCS33109
Participating Start Date
10/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #2426
39 WEST SIDE MALL
EDWARDSVILLE, PA 18704-3113
Pharmacy Comments
Contract Details
Approval Date
9/3/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Maria Montoro Edwards, Vice President of Grants & Strategic Initiatives
(570) 343-2383 Ext: 2091
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/12/2019
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