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RITE AID OF PENNSYLVANIA, LLC
CAH391313-00 CHARLES COLE MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CHARLES COLE MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH391313-00
Entity Address
1001 EAST 2ND STREET
COUDERSPORT, PA 16915
Medicare Provider Number
391313
Participating Start Date
8/25/2010
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #1976
207 ROUTE 6 WEST
COUDERSPORT, PA 16915
Pharmacy Comments
Contract Details
Approval Date
9/12/2012
Contract Begin Date
10/1/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
EDWARD C PITCHFORD, PRESIDENT & CEO
(814) 260-5216
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
8/29/2012
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