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RITE AID OF PENNSYLVANIA, LLC
DSH390133 LEHIGH VALLEY
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Covered Entity Details
Entity Name
LEHIGH VALLEY
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390133
Entity Address
1200 South Cedar Crest Boulevard
ALLENTOWN, PA 18103-4000
Medicare Provider Number
390133
Participating Start Date
1/1/2023
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1355
504 MARION LN
BRODHEADSVILLE, PA 18322-7064
Pharmacy Comments
Contract Details
Approval Date
1/5/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/7/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/5/2023
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