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RITE AID OF PENNSYLVANIA, LLC
RRC390049-00 ST. LUKES HOSPITAL
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Covered Entity Details
Entity Name
ST. LUKES HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390049-00
Entity Address
801 OSTRUM STREET
BETHLEHEM, PA 18015
Medicare Provider Number
390049
Participating Start Date
10/1/2018
Last Recertification Date
9/13/2021
Entity Termination Date
1/1/2022
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #7836
1401 W TILGHMAN STREET
ALLENTOWN, PA 18102
Pharmacy Comments
Contract Details
Approval Date
7/21/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Elizabeth Artis, Finance Director
(484) 526-4707
Contract Pharmacy Representative
Rite Aid
David Bell, Rep
(717) 761-2633 Ext: 5311
Signed By Date
7/21/2020
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