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RITE AID OF PENNSYLVANIA, LLC
RRC390001-00 COMMUNITY MEDICAL CENTER
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Covered Entity Details
Entity Name
COMMUNITY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC390001-00
Entity Address
1800 MULBERRY STREET
SCRANTON, PA 18510
Medicare Provider Number
390001
Participating Start Date
1/1/2024
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1180
217 SOUTH BLAKELY STREET
DUNMORE, PA 18512
Pharmacy Comments
Contract Details
Approval Date
11/27/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/22/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ron Beer, Chief Admiistrative Officer
(570) 808-5380
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
10/17/2023
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