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RITE AID OF PENNSYLVANIA, LLC
CH030220P Broad Top Area Medical Center, Inc., The
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Covered Entity Details
Entity Name
Broad Top Area Medical Center, Inc., The
Subdivision Name
BTAMC, Inc. SHCMC Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CH030220P
Entity Address
626 Water Street STE 2
Orbisonia, PA 17243
Grant Number
H80CS00330
Participating Start Date
10/1/2022
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #233
9635 WILLIAM PENN HIGHWAY
HUNTINGDON, PA 16652
Pharmacy Comments
Contract Details
Approval Date
7/14/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Roth, CEO
(814) 635-7351
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
7/14/2024
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