Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
CH020110 WHITNEY M. YOUNG, JR., HEALTH CENTER, INC.

Covered Entity Details

Entity Name

WHITNEY M. YOUNG, JR., HEALTH CENTER, INC.

Subdivision Name

WHITNEY M. YOUNG, JR. HEALTH CENTER

Type

HRSA-Funded Health Center

340B ID

CH020110

Entity Address

920 Lark Dr
Albany, NY 12207-1300

Grant Number

H80CS00433

Participating Start Date

10/1/1995

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #537
17-21 NORTH PEARL STREET
ALBANY, NY 12207

Pharmacy Comments

Contract Details

Approval Date

12/17/2012

Contract Begin Date

10/27/2012

Carve-In Effective Date

Contract Comments

12/17/2012 - public health emergency declared in the state of NY effective 10/27/2012

Contract Termination Date
Termination Reason

3/20/2018
Ownership change

Contacts

Covered Entity Signing Official

David H. Shippee, President & CEO
(518) 591-4459

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

11/27/2012

340B Drug Pricing Program Database