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RITE AID OF PENNSYLVANIA, LLC
CH03170L CENTERVILLE CLINIC INC
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Covered Entity Details
Entity Name
CENTERVILLE CLINIC INC
Subdivision Name
Charleroi Medical &tal Center
Type
HRSA-Funded Health Center
340B ID
CH03170L
Entity Address
200 Chamber Plz
Charleroi, PA 15022-1605
Grant Number
H80CS00705
Participating Start Date
1/1/2020
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #4083
101 5TH STREET
CHARLEROI, PA 15022
Pharmacy Comments
Contract Details
Approval Date
10/7/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barry R Niccolai, Executive Director
(724) 632-6801 Ext: 1100
Contract Pharmacy Representative
Rite Aid
Owen McMahon, GVP, Enterprise Pharmaceutical Purchasing
(717) 214-2505
Signed By Date
10/7/2024
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