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RITE AID OF PENNSYLVANIA, LLC
CH031220 N PENN COMPREHENSIVE HEALTH SVCS
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Covered Entity Details
Entity Name
N PENN COMPREHENSIVE HEALTH SVCS
Subdivision Name
North Penn Comprehensive Health Services, Laurel Health Center Administration
Type
HRSA-Funded Health Center
340B ID
CH031220
Entity Address
40 W. Wellsboro St
Mansfield, PA 16933
Grant Number
H80CS00682
Participating Start Date
1/1/2009
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1976
207 ROUTE 6 WEST
COUDERSPORT, PA 16915
Pharmacy Comments
Contract Details
Approval Date
7/8/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ronald M Gilbert, CFO
(570) 828-3869
Contract Pharmacy Representative
Rite Aid Pharmacy
Alison Farrell, Senior Vice President
(717) 214-8834
Signed By Date
7/8/2021
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