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RITE AID OF PENNSYLVANIA, LLC
CH03230C KEYSTONE RURAL HEALTH CONSORTIA INC
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Covered Entity Details
Entity Name
KEYSTONE RURAL HEALTH CONSORTIA INC
Subdivision Name
Johnsonburg Dental Center
Type
HRSA-Funded Health Center
340B ID
CH03230C
Entity Address
81 Clarion Rd
Johnsonburg, PA 15845-1656
Grant Number
H80CS00688
Participating Start Date
10/1/2014
Last Recertification Date
1/29/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #2476
101 MAIN STREET
RIDGWAY, PA 15853
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kristie Bennardi, CEO
(814) 486-1115
Contract Pharmacy Representative
Rite Aid
Allison Ferrell, Vice Presicdent Managed Care
(717) 975-5978
Signed By Date
1/15/2020
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