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RITE AID OF PENNSYLVANIA, LLC
CHC26634-00 PHILADELPHIA FIGHT
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Covered Entity Details
Entity Name
PHILADELPHIA FIGHT
Subdivision Name
Philadelphia FIGHT Jonathan Lax Treatment Center
Type
HRSA-Funded Health Center
340B ID
CHC26634-00
Entity Address
1233 Locust Street Floor 5, Suite 500 and Floor 4, Suite 400
Philadelphia, PA 19107-5453
Grant Number
H80CS26634
Participating Start Date
4/1/2014
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #679
123 SOUTH 69TH STREET
UPPER DARBY, PA 19082
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
11/15/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/19/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JANE SHULL, EXECUTIVE DIRECTOR
(215) 985-4448 Ext: 102
Contract Pharmacy Representative
RiteAid
Christopher Moen, VP, Strategic Pharmacy Relationship
(717) 791-3129
Signed By Date
10/14/2022
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