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RITE AID OF PENNSYLVANIA, LLC
CHC00071-01 COVENANT HOUSE INC
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Covered Entity Details
Entity Name
COVENANT HOUSE INC
Subdivision Name
Covenant House Medical Center
Type
HRSA-Funded Health Center
340B ID
CHC00071-01
Entity Address
8125-27 Stenton Avenue
Philadelphia, PA UDFND
Grant Number
H80CS00071
Participating Start Date
1/1/2025
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #679
123 SOUTH 69TH STREET
UPPER DARBY, PA 19082
Pharmacy Comments
Contract Details
Approval Date
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susan Stukes, Chief Executive Officer
(215) 844-1020 Ext: 219
Contract Pharmacy Representative
RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086
Signed By Date
10/15/2024
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