Contract Pharmacy Details

RITE AID OF PENNSYLVANIA, LLC
CH030220F BROAD TOP AREA MEDICAL CENTER, INC.

Covered Entity Details

Entity Name

BROAD TOP AREA MEDICAL CENTER, INC.

Subdivision Name

BROAD TOP AREA MEDICAL CENTER, INC.

Type

HRSA-Funded Health Center

340B ID

CH030220F

Entity Address

4133 MEDICAL CENTER DRIVE
BROAD TOP, PA 16621-9001

Grant Number

H80CS00330

Participating Start Date

4/1/2017

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

RITE AID OF PENNSYLVANIA, LLC

Pharmacy Address

RITE AID #233
9635 WILLIAM PENN HIGHWAY
HUNTINGDON, PA 16652

Pharmacy Comments

Contract Details

Approval Date

7/13/2020

Contract Begin Date

7/13/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Roth, CEO
(814) 635-7351

Contract Pharmacy Representative

RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086

Signed By Date

7/13/2020

340B Drug Pricing Program Database