Contract Pharmacy Details

RITE AID DRUG PALACE, INC.
CH020490 William F. Ryan Community Health Center, Inc.

Covered Entity Details

Entity Name

William F. Ryan Community Health Center, Inc.

Subdivision Name

Ryan Health | West 97th Street

Type

HRSA-Funded Health Center

340B ID

CH020490

Entity Address

110 W 97th St
NEW YORK, NY 10025-6450

Grant Number

H80CS00061

Participating Start Date

7/1/1998

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

RITE AID DRUG PALACE, INC.

Pharmacy Address

RITE AID #1711
408 GRAND STREET
NEW YORK, NY 10002

Pharmacy Comments

Contract Details

Approval Date

10/15/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/18/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

Scott D. Morgan, Chief Financial Officer
(212) 769-7245

Contract Pharmacy Representative

Rite Aid
Lisa Foster, Manager-Pharmacy
(717) 214-2518

Signed By Date

10/15/2019

340B Drug Pricing Program Database