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THE LANE DRUG COMPANY
DSH390009 SAINT VINCENT HEALTH CENTER
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Covered Entity Details
Entity Name
SAINT VINCENT HEALTH CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390009
Entity Address
232 WEST 25TH STREET
ERIE, PA 16544-0002
Medicare Provider Number
390009
Participating Start Date
7/1/2008
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
THE LANE DRUG COMPANY
Pharmacy Address
RITE AID #2382
163 WEST 26TH STREET
ERIE, PA 16508
Pharmacy Comments
Contract Details
Approval Date
7/7/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
THOMAS FUCCI, EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER
(814) 452-5112
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
7/7/2014
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