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RITE AID OF PENNSYLVANIA, LLC
CH03122M N Penn Comprehensive Health Svcs
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Covered Entity Details
Entity Name
N Penn Comprehensive Health Svcs
Subdivision Name
Laurel Behavioral Health Outpatient Services
Type
HRSA-Funded Health Center
340B ID
CH03122M
Entity Address
114 East Avenue
Wellsboro, PA 16901
Grant Number
H80CS00682
Participating Start Date
1/1/2020
Last Recertification Date
2/22/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1976
207 ROUTE 6 WEST
COUDERSPORT, PA 16915
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ronald M Gilbert, CFO
(570) 828-3869
Contract Pharmacy Representative
Rite Aid Pharmacy
Alison Farrell, Senior Vice President
(717) 214-8834
Signed By Date
4/15/2022
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