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RITE AID OF NEW YORK, INC.
CH02179I HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Moriah Health Center
Type
HRSA-Funded Health Center
340B ID
CH02179I
Entity Address
33 TOM PHELPS LANE
MINEVILLE, NY 12956
Grant Number
H80CS00159
Participating Start Date
1/1/2007
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #458
1262 DIX AVENUE
HUDSON FALLS, NY 12839
Pharmacy Comments
Contract Details
Approval Date
3/7/2012
Contract Begin Date
3/7/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/8/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
2/20/2012
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