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RITE AID OF PENNSYLVANIA, LLC
FQHCLA394L Wright Center Medical Group, P.C., The
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Covered Entity Details
Entity Name
Wright Center Medical Group, P.C., The
Subdivision Name
The Wright Center for Community Health Wayne Practice
Type
Health Center Program Look-Alike
340B ID
FQHCLA394L
Entity Address
1855 Fair Ave
Honesdale, PA 18431-2121
Grant Number
LALCS33109
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1426
1650 MAIN STREET
OLYPHANT, PA 18447
Pharmacy Comments
Contract Details
Approval Date
4/8/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jignesh Sheth, Senior VP for Clinical Operations
(570) 687-4232
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/8/2024
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