Contract Pharmacy Details

Rite Aid 6811
CAH391316-00 WELLSBORO

Covered Entity Details

Entity Name

WELLSBORO

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH391316-00

Entity Address

32-36 CENTRAL AVENUE
WELLSBORO, PA 16901

Medicare Provider Number

391316

Participating Start Date

4/1/2017

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

Rite Aid 6811

Pharmacy Address

701 Delran Pkwy
Delran, NJ 08075

Pharmacy Comments

Contract Details

Approval Date

4/9/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Roger C Yost, CFO, North-Central PA Region
(570) 321-3175

Contract Pharmacy Representative

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

Signed By Date

4/9/2025

340B Drug Pricing Program Database