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RITE AID OF PENNSYLVANIA, LLC
DSH390195 LANKENAU MEDICAL CENTER
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Covered Entity Details
Entity Name
LANKENAU MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390195
Entity Address
100 LANCASTER AVE.
WYNNEWOOD, PA 19096
Medicare Provider Number
390195
Participating Start Date
4/1/2023
Last Recertification Date
8/12/2024
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
2/2/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/19/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Yonathan M Kebede, Vice President, Operations
(614) 323-9829
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
1/17/2023
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