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RITE AID OF PENNSYLVANIA, LLC
DSH390198 MILLCREEK COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MILLCREEK COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390198
Entity Address
5515 Peach Street
ERIE, PA 16509
Medicare Provider Number
390198
Participating Start Date
12/28/2020
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1699
9141 RIDGE ROAD
GIRARD, PA 16417
Pharmacy Comments
Contract Details
Approval Date
12/28/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marcus Chase Babiak, Chief Operating Officer
(814) 868-7733
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
12/18/2020
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