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RITE AID OF PENNSYLVANIA, LLC
RRC390195-00 LANKENAU MEDICAL CENTER
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Covered Entity Details
Entity Name
LANKENAU MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390195-00
Entity Address
100 LANCASTER AVE.
WYNNEWOOD, PA 19096
Medicare Provider Number
390195
Participating Start Date
1/1/2020
Last Recertification Date
8/31/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1320
640 MONTGOMERY AVENUE
NARBERTH, PA 19072
Pharmacy Comments
Contract Details
Approval Date
7/14/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Phil D Robinson, President
(484) 476-2027
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
7/14/2022
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