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RITE AID OF PENNSYLVANIA, LLC
FQHCLA399 MULTI-CULTURAL HEALTH EVALUATION DELIVERY SYSTEM, INC.
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Covered Entity Details
Entity Name
MULTI-CULTURAL HEALTH EVALUATION DELIVERY SYSTEM, INC.
Subdivision Name
MHEDS Peach Street Site
Type
Health Center Program Look-Alike
340B ID
FQHCLA399
Entity Address
2928 PEACH ST
ERIE, PA 16508
Grant Number
LALCS32712
Participating Start Date
1/1/2020
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #213
2715 PARADE STREET
ERIE, PA 16504
Pharmacy Comments
Contract Details
Approval Date
12/5/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Patricia J Stubber, CEO
(814) 453-6229
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
12/5/2019
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