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RITE AID OF PENNSYLVANIA, LLC
CH03122L N Penn Comprehensive Health Svcs
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Covered Entity Details
Entity Name
N Penn Comprehensive Health Svcs
Subdivision Name
Wellsboro Laurel Pediatric Center
Type
HRSA-Funded Health Center
340B ID
CH03122L
Entity Address
1B Main St
Wellsboro, PA 16901-1601
Grant Number
H80CS00682
Participating Start Date
1/1/2020
Last Recertification Date
3/5/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #561
2968 ELMIRA STREET
SAYRE, PA 18840
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
8/2/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ronald M Gilbert, CFO
(570) 828-3869
Contract Pharmacy Representative
Rite Aid Pharmacy
Christopher Moen, VP, Strategic Pharmacy Relations
(717) 791-3129
Signed By Date
4/15/2022
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