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RITE AID OF NEW YORK, INC.
CH020870 NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
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Covered Entity Details
Entity Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC
Subdivision Name
NORTHERN OSWEGO COUNTY HEALTH SERVICES, INC.
Type
HRSA-Funded Health Center
340B ID
CH020870
Entity Address
61 Delano St
Pulaski, NY 13142-1400
Grant Number
H80CS00166
Participating Start Date
10/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #4457
110 EAST BROADWAY
FULTON, NY 13069
Pharmacy Comments
Contract Details
Approval Date
4/8/2013
Contract Begin Date
4/8/2013
Carve-In Effective Date
Contract Comments
04/09/2013 - public health emergency declared in the state of NY effective 10/27/2012
Contract Termination Date
Termination Reason
2/14/2018
Ownership change
Contacts
Covered Entity Signing Official
Daniel T. Dey, CEO
(315) 298-6569 Ext: 2003
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
4/8/2013
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