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RITE AID OF PENNSYLVANIA, LLC
DSH390030 Lehigh Valley Hospital - Schuylkill
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Covered Entity Details
Entity Name
Lehigh Valley Hospital - Schuylkill
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390030
Entity Address
420 South Jackson Street
Pottsville, PA 17901-3625
Medicare Provider Number
390030
Participating Start Date
10/1/2018
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #2478
129 EAST CENTRE STREET
ASHLAND, PA 17921
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/26/2022
Business decision by covered entity and/or pharmacy
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
10/12/2021
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