340B Drug Pricing Program Database

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #3864
4102 CHURCH AVENUE
BROOKLYN, NY 11203

Pharmacy Comments

Approval Date

11/9/2012

Contract Begin Date

10/27/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/11/2023
Business decision by covered entity and/or pharmacy

Covered Entity Signing Official

Antonio Martin, Ececutive Vice President & Chief Operating Officier
(212) 788-3479

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

10/27/2012