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RITE AID OF OHIO, INC.
CH057110 THIRD STREET COMMUNITY CLINIC
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Covered Entity Details
Entity Name
THIRD STREET COMMUNITY CLINIC
Subdivision Name
Third Street Community Clinic, Inc
Type
HRSA-Funded Health Center
340B ID
CH057110
Entity Address
600 W 3rd St
Mansfield, OH 44906-2633
Grant Number
H80CS00581
Participating Start Date
10/1/2001
Last Recertification Date
2/21/2025
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
4/15/2020
Contract Begin Date
4/29/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brett Toward, CEO/CMO
(419) 522-6191
Contract Pharmacy Representative
Rite Aid
Lisa Foster, Manager-Pharmacy
(717) 214-2518
Signed By Date
4/15/2020
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