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RITE AID OF NEW YORK, INC.
DSH330232 SETON HEALTH SYSTEM
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Covered Entity Details
Entity Name
SETON HEALTH SYSTEM
Subdivision Name
St. Mary's Hospital
Type
Disproportionate Share Hospital
340B ID
DSH330232
Entity Address
1300 MASSACHUSETTS AVE
TROY, NY 12180
Medicare Provider Number
330232
Participating Start Date
10/1/2009
Last Recertification Date
8/28/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #784
1022 ROUTE 146
CLIFTON PARK, NY 12065
Pharmacy Comments
Contract Details
Approval Date
10/22/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/6/2018
Ownership change
Contacts
Covered Entity Signing Official
Daniel Kochie, CFO
(518) 268-5335
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
10/22/2013
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