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RITE AID OF PENNSYLVANIA, LLC
DSH390142 ALBERT EINSTEIN MEDICAL CENTER
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Covered Entity Details
Entity Name
ALBERT EINSTEIN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390142
Entity Address
5501 OLD YORK ROAD
PHILADELPHIA, PA 19141
Medicare Provider Number
390142
Participating Start Date
1/1/2005
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1016
8130 ROOSEVELT BOULEVARD
PHILADELPHIA, PA 19152
Pharmacy Comments
Contract Details
Approval Date
1/14/2022
Contract Begin Date
1/25/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/5/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
GERARD BLANEY, CHIEF FINANCIAL OFFICER
(215) 456-6020
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
1/14/2022
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