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RITE AID OF NEW YORK, INC.
CH021200 BETANCES HEALTH CENTER
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Covered Entity Details
Entity Name
BETANCES HEALTH CENTER
Subdivision Name
BETANCES HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH021200
Entity Address
280 Henry St
New York, NY 10002-4816
Grant Number
H80CS00235
Participating Start Date
10/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #3771
85 AVENUE D
NEW YORK, NY 10009
Pharmacy Comments
Contract Details
Approval Date
1/9/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/18/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Julia Tsien, CEO
(212) 227-8401 Ext: 101
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/9/2020
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