Contract Pharmacy Details

RITE AID OF PENNSYLVANIA, LLC
CAH391315-00 Elk Regional Health Center

Covered Entity Details

Entity Name

Elk Regional Health Center

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH391315-00

Entity Address

763 Johnsonburg RD
St. Marys, PA 15857

Medicare Provider Number

391315

Participating Start Date

1/1/2017

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

RITE AID OF PENNSYLVANIA, LLC

Pharmacy Address

RITE AID #7850
620 E ALLEGHENY AVENUE
EMPORIUM, PA 15834

Pharmacy Comments

Contract Details

Approval Date

1/15/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/15/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Laurie MacDonald, Chief Financial Officer
(814) 788-8743

Contract Pharmacy Representative

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

Signed By Date

1/15/2021

340B Drug Pricing Program Database