Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
CH0112230 COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION

Covered Entity Details

Entity Name

COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION

Subdivision Name

CHC'S OF RUTLAND REGION, INC.

Type

HRSA-Funded Health Center

340B ID

CH0112230

Entity Address

275 Route 30 N
Bomoseen, VT 05732-9647

Grant Number

H80CS06659

Participating Start Date

7/1/2006

Last Recertification Date

2/27/2025

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #676
116 QUAKER STREET
GRANVILLE, NY 12832

Pharmacy Comments

Contract Details

Approval Date

10/19/2012

Contract Begin Date

10/19/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2018
Ownership change

Contacts

Covered Entity Signing Official

GRANT WHITMER, EXECUTIVE DIRECTOR
(802) 855-2081

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

9/7/2012

340B Drug Pricing Program Database