Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
DSH330223 MASSENA MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

MASSENA MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH330223

Entity Address

1 HOSPITAL DRIVE
MASSENA, NY 13662

Medicare Provider Number

330223

Participating Start Date

7/1/2010

Last Recertification Date

9/7/2016

Entity Termination Date

4/1/2017

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #4998
87 MAIN STREET
MASSENA, NY 13662

Pharmacy Comments

Contract Details

Approval Date

9/12/2012

Contract Begin Date

9/12/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2017
Covered Entity Terminated

Contacts

Covered Entity Signing Official

SEAN M. CURTIN, CHIEF FINANCIAL OFFICER
(315) 769-4207

Contract Pharmacy Representative

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

Signed By Date

8/28/2012

340B Drug Pricing Program Database