Contract Pharmacy Details

RITE AID OF PENNSYLVANIA, LLC
RRC390133-00 LEHIGH VALLEY HOSPITAL

Covered Entity Details

Entity Name

LEHIGH VALLEY HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC390133-00

Entity Address

1200 South Cedar Crest Boulevard
Allentown, PA 18103

Medicare Provider Number

390133

Participating Start Date

1/1/2018

Last Recertification Date

8/31/2022

Entity Termination Date

1/1/2023

Pharmacy Details

Pharmacy Name

RITE AID OF PENNSYLVANIA, LLC

Pharmacy Address

RITE AID #1450
601 DELAWARE AVENUE
PALMERTON, PA 18071

Pharmacy Comments

Contract Details

Approval Date

1/14/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

1/14/2021

340B Drug Pricing Program Database