Contract Pharmacy Details

RITE AID OF OHIO, INC.
CHC28349-00 SPRINGVALE HEALTH CENTERS, INC.

Covered Entity Details

Entity Name

SPRINGVALE HEALTH CENTERS, INC.

Subdivision Name

204 Bellevue St.

Type

HRSA-Funded Health Center

340B ID

CHC28349-00

Entity Address

204 S Bellevue Ave
Dover, OH 44622-9405

Grant Number

H80CS28349

Participating Start Date

8/18/2021

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

RITE AID OF OHIO, INC.

Pharmacy Address

RITE AID #3468
340 WEST MAIN STREET
CARROLLTON, OH 44615

Pharmacy Comments

Contract Details

Approval Date

9/13/2021

Contract Begin Date

9/13/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/13/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Joseph Boroski, Chief Executive Officer
(330) 343-6631

Contract Pharmacy Representative

RITE AID
REBECCA BADDORF, MANAGER, PHARMACEUTICAL REPLENISHMENT PROGRAMS
(717) 214-2518

Signed By Date

9/13/2021

340B Drug Pricing Program Database