Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
FQHCLA342B Trillium Health, Inc.

Covered Entity Details

Entity Name

Trillium Health, Inc.

Subdivision Name

Trillium Health Mobile Access Clinic (MAC)

Type

Health Center Program Look-Alike

340B ID

FQHCLA342B

Entity Address

170 Science Pkwy
Rochester, NY 14620-4251

Grant Number

LALCS00182

Participating Start Date

4/1/2020

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #3597
535 PORTLAND AVENUE
ROCHESTER, NY 14621

Pharmacy Comments

Contract Details

Approval Date

1/24/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

6/16/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Gregory Clyde Ewing, S.V.P. Compliance, Privacy, Technology & Regulatory Affairs/CCO
(585) 545-7218

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968

Signed By Date

1/24/2022

340B Drug Pricing Program Database