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RITE AID OF PENNSYLVANIA, LLC
DSH390115 Jefferson Health Northeast
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Covered Entity Details
Entity Name
Jefferson Health Northeast
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390115
Entity Address
10800 Knights Rd.
PHILADELPHIA, PA 19114
Medicare Provider Number
390115
Participating Start Date
10/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #3637
6363 FRANKFORD AVENUE
PHILADELPHIA, PA 19135
Pharmacy Comments
Contract Details
Approval Date
7/20/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CARRIE FREY, Director of Finance
(215) 612-4313
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/20/2020
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