Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH330005 KALEIDA HEALTH

Covered Entity Details

Entity Name

KALEIDA HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330005

Entity Address

100 High Street
BUFFALO, NY 14203

Medicare Provider Number

330005

Participating Start Date

4/1/2006

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #650
419 DIVISION STREET
NORTH TONAWANDA, NY 14120

Pharmacy Comments

Contract Details

Approval Date

1/13/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/19/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Robert Joseph Nesselbush, EVP, CFO
(716) 859-1215

Contract Pharmacy Representative

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

Signed By Date

1/13/2020

340B Drug Pricing Program Database