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RITE AID OF PENNSYLVANIA, LLC
DSH390049 ST. LUKES HOSPITAL
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Covered Entity Details
Entity Name
ST. LUKES HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390049
Entity Address
801 OSTRUM STREET
BETHLEHEM, PA 18015
Medicare Provider Number
390049
Participating Start Date
1/1/2022
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #7836
1401 W TILGHMAN STREET
ALLENTOWN, PA 18102
Pharmacy Comments
Contract Details
Approval Date
11/10/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Elizabeth Artis, Finance Director
(484) 526-4707
Contract Pharmacy Representative
Rite Aid
David Bell, Rep
(717) 761-2633 Ext: 5311
Signed By Date
10/14/2021
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