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RITE AID OF DELAWARE, INC.
DSH080009 Bayhealth Hospital Sussex Campus
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Covered Entity Details
Entity Name
Bayhealth Hospital Sussex Campus
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH080009
Entity Address
100 Wellness Way
MILFORD, DE 19963
Medicare Provider Number
080009
Participating Start Date
3/15/2022
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
RITE AID OF DELAWARE, INC.
Pharmacy Address
RITE AID #3749
677 NORTH DUPONT BLVD
MILFORD, DE 19963
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
3/15/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael James Tretina, CFO
(302) 744-7162
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/14/2020
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