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RITE AID OF PENNSYLVANIA, LLC
CHC08760-17 WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
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Covered Entity Details
Entity Name
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Subdivision Name
Waymart Pediatric Center
Type
HRSA-Funded Health Center
340B ID
CHC08760-17
Entity Address
27B Woodlands Dr
Waymart, PA 18472-9366
Grant Number
H80CS08760
Participating Start Date
1/1/2020
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #2768
54 NORTH MAIN STREET
CARBONDALE, PA 18407
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Robert J. Fortuner II, Finance Director
(570) 253-8337
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President Managed Care
(717) 214-8538
Signed By Date
10/13/2023
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