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ECKERD CORPORATION
DSH390201 POCONO MEDICAL CENTER
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Covered Entity Details
Entity Name
POCONO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390201
Entity Address
206 EAST BROWN STREET
EAST STROUDSBURG, PA 18301-3006
Medicare Provider Number
390201
Participating Start Date
3/15/2022
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ECKERD CORPORATION
Pharmacy Address
RITE AID #11063
228 MAIN ST
STROUDSBURG, PA 18360-2502
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Stephen Patrick Molitoris, Vice President
(484) 884-0974
Contract Pharmacy Representative
Rite Aid Pharmacy
Christopher Moen, VP, Strategic Pharmacy Relations
(717) 791-3129
Signed By Date
10/8/2021
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