Contract Pharmacy Details

RITE AID OF PENNSYLVANIA, LLC
SCH390056-00 PENN HIGHLANDS HUNTINGDON

Covered Entity Details

Entity Name

PENN HIGHLANDS HUNTINGDON

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH390056-00

Entity Address

1225 WARM SPRINGS AVENUE
HUNTINGDON, PA 16652-2350

Medicare Provider Number

390056

Participating Start Date

7/21/2021

Last Recertification Date

8/15/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

RITE AID OF PENNSYLVANIA, LLC

Pharmacy Address

RITE AID #6739
1365 LOGAN AVENUE
TYRONE, PA 16686

Pharmacy Comments

Contract Details

Approval Date

10/28/2014

Contract Begin Date

10/28/2014

Carve-In Effective Date

Contract Comments

10/28/2014 Immediate begin date authorized

Contract Termination Date
Termination Reason

2/24/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Edward M. Quinn, CHIEF FINANCIAL OFFICER
(814) 643-8445

Contract Pharmacy Representative

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

Signed By Date

10/28/2014

340B Drug Pricing Program Database