Contract Pharmacy Details

RITE AID OF GEORGIA, INC.
DSH110024 CANDLER HOSPITAL

Covered Entity Details

Entity Name

CANDLER HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH110024

Entity Address

5353 REYNOLDS STREET
SAVANNAH, GA 31405

Medicare Provider Number

110024

Participating Start Date

10/1/2004

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

RITE AID OF GEORGIA, INC.

Pharmacy Address

RITE AID #1502
1038 WEST HIGHWAY 80
POOLER, GA 31322

Pharmacy Comments

Contract Details

Approval Date

4/24/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/13/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

PAUL P. HINCHEY, CEO
(912) 819-6901

Contract Pharmacy Representative

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

Signed By Date

4/24/2017

340B Drug Pricing Program Database