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RITE AID OF PENNSYLVANIA, LLC
FQHCLA399A MULTI-CULTURAL HEALTH EVALUATION DELIVERY SYSTEM, INC.
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Covered Entity Details
Entity Name
MULTI-CULTURAL HEALTH EVALUATION DELIVERY SYSTEM, INC.
Subdivision Name
MHEDS-John F. Kennedy Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA399A
Entity Address
2021 E 20th St
Erie, PA 16510
Grant Number
LALCS32712
Participating Start Date
1/1/2021
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1376
916 STATE STREET
ERIE, PA 16501
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alivia Haibach, CEO
(814) 453-6229
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
7/12/2024
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