Contract Pharmacy Details

RITE AID OF OHIO, INC.
SCH360040-00 KNOX COMMUNITY HOSPITAL

Covered Entity Details

Entity Name

KNOX COMMUNITY HOSPITAL

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH360040-00

Entity Address

1330 COSHOCTON AVE
MOUNT VERNON, OH 43050

Medicare Provider Number

360040

Participating Start Date

10/1/2014

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

RITE AID OF OHIO, INC.

Pharmacy Address

RITE AID #3266
117 SOUTH MAIN STREET
FREDERICKTOWN, OH 43019

Pharmacy Comments

Contract Details

Approval Date

1/10/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/20/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

MICHAEL AMBROSIANI, CHIEF FINANCIAL OFFICER
(740) 393-9623

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968

Signed By Date

1/10/2020

340B Drug Pricing Program Database