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RITE AID OF PENNSYLVANIA, LLC
DSH390178 UPMC HORIZON HOSPITAL
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Covered Entity Details
Entity Name
UPMC HORIZON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390178
Entity Address
110 NORTH MAIN STREET
GREENVILLE, PA 16125
Medicare Provider Number
390178
Participating Start Date
4/1/2017
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1699
9141 RIDGE ROAD
GIRARD, PA 16417
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Tracy, Jr., CFO
(724) 656-4107
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
10/16/2023
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