Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH330239 UPMC CHAUTAUQUA AT WCA

Covered Entity Details

Entity Name

UPMC CHAUTAUQUA AT WCA

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330239

Entity Address

207 Foote Avenue
JAMESTOWN, NY 14701

Medicare Provider Number

330239

Participating Start Date

10/1/2019

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #568
50 SOUTH MAIN STREET
JAMESTOWN, NY 14701

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

Brad N Dinger, CFO
(814) 877-3739

Contract Pharmacy Representative

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

Signed By Date

10/16/2023

340B Drug Pricing Program Database