Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
FQHCLA342B Trillium Health, Inc.

Covered Entity Details

Entity Name

Trillium Health, Inc.

Subdivision Name

Trillium Health Mobile Access Clinic (MAC)

Type

Health Center Program Look-Alike

340B ID

FQHCLA342B

Entity Address

170 Science Pkwy
Rochester, NY 14620-4251

Grant Number

LALCS00182

Participating Start Date

4/1/2020

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #629
1000 NORTH CLINTON AVENUE
ROCHESTER, NY 14621

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

Gregory Clyde Ewing, S.V.P. Compliance, Privacy, Technology & Regulatory Affairs/CCO
(585) 545-7218

Contract Pharmacy Representative

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

Signed By Date

7/12/2024

340B Drug Pricing Program Database