340B Drug Pricing Program Database
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RITE AID OF PENNSYLVANIA, LLC
RWII16214 Pennsylvania Western University
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Covered Entity Details
Entity Name
Pennsylvania Western University
Subdivision Name
PA Thrive Partnership
Type
Ryan White Part B
340B ID
RWII16214
Entity Address
867 E Main St
Suite 209
Clarion, PA 16214
Grant Number
X07HA00021
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1854
1709 LIBERTY STREET
ERIE, PA 16502
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
6/29/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Amy Heather Esterhuizen, GRANTS OFFICER
(814) 393-2162
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/15/2021
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