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RITE AID OF PENNSYLVANIA, LLC
CH033200 GREATER PHILADELPHIA HEALTH ACTION, INCORPORATED
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Covered Entity Details
Entity Name
GREATER PHILADELPHIA HEALTH ACTION, INCORPORATED
Subdivision Name
Carl Moore Health Center
Type
HRSA-Funded Health Center
340B ID
CH033200
Entity Address
1401 S. 31st Street
Philadelphia, PA 19146
Grant Number
H80CS00708
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #2587
3260 NORTH BROAD STREET
PHILADELPHIA, PA 19140
Pharmacy Comments
Contract Details
Approval Date
10/21/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/27/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Brian Clark, CEO
(215) 925-2400 Ext: 1060
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/21/2019
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