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RITE AID OF NEW YORK, INC.
CH022070 ANTHONY L JORDAN HEALTH CORP
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Covered Entity Details
Entity Name
ANTHONY L JORDAN HEALTH CORP
Subdivision Name
Main Site
Type
HRSA-Funded Health Center
340B ID
CH022070
Entity Address
82 Holland St
Rochester, NY 14605-2131
Grant Number
H80CS21582
Participating Start Date
10/1/2011
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #621
804 NORTH GOODMAN STREET
ROCHESTER, NY 14609
Pharmacy Comments
Contract Details
Approval Date
7/2/2014
Contract Begin Date
10/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/13/2018
Ownership change
Contacts
Covered Entity Signing Official
Jonathan Clune, CFO
(585) 423-2813
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
7/2/2014
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