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RITE AID OF PENNSYLVANIA, LLC
CAH391312-00 BROOKVILLE HOSPITAL
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Covered Entity Details
Entity Name
BROOKVILLE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391312-00
Entity Address
100 HOSPITAL ROAD
BROOKVILLE, PA 15825
Medicare Provider Number
391312
Participating Start Date
1/1/2011
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1548
610 BROAD STREET
NEW BETHLEHEM, PA 16242
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JULIANNE PEER, President
(814) 849-1461
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/13/2020
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