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RITE AID OF PENNSYLVANIA, LLC
PED393302-00 UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
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Covered Entity Details
Entity Name
UPMC CHILDREN'S HOSPITAL OF PITTSBURGH
Subdivision Name
Type
Children's Hospital
340B ID
PED393302-00
Entity Address
4401 PENN AVENUE
PITTSBURGH, PA 15224
Medicare Provider Number
393302
Participating Start Date
1/1/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1549
630 MAIN ST.
PORTAGE, PA 15946
Pharmacy Comments
Contract Details
Approval Date
7/12/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mario Edward Wilfong, CFO
(412) 692-8201
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
7/12/2023
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