Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH390063 UPMC HAMOT

Covered Entity Details

Entity Name

UPMC HAMOT

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH390063

Entity Address

201 STATE STREET
ERIE, PA 16550

Medicare Provider Number

390063

Participating Start Date

4/1/2015

Last Recertification Date

9/6/2024

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