Contract Pharmacy Details

RITE AID OF PENNSYLVANIA, LLC
DSH390133 LEHIGH VALLEY

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 #873
500 N. CLAUDE LORD BOULEVARD
POTTSVILLE, PA 17901

Pharmacy Comments

Contract Details

Approval Date

7/7/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/16/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943

Contract Pharmacy Representative

RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086

Signed By Date

7/7/2023

340B Drug Pricing Program Database