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GENOVESE DRUG STORES, INC.
CH02151BG Sun River Health, Inc.
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Covered Entity Details
Entity Name
Sun River Health, Inc.
Subdivision Name
LISH at Port Jefferson Station
Type
HRSA-Funded Health Center
340B ID
CH02151BG
Entity Address
51 Terryville Rd
Port Jefferson Station, NY 11776
Grant Number
H80CS00313
Participating Start Date
1/1/2017
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
GENOVESE DRUG STORES, INC.
Pharmacy Address
RITE AID #10657
397 SUNRISE HIGHWAY
WEST PATCHOGUE, NY 11772
Pharmacy Comments
Contract Details
Approval Date
4/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/2/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Allison Dubois-Adach, COO
(914) 734-8503
Contract Pharmacy Representative
Rite Aid
Owen McMahon, GVP, Enterprise Pharmaceutical Purchasing
(717) 214-2505
Signed By Date
4/10/2023
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