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RITE AID OF DELAWARE, INC.
DSH390180 Crozer Chester Medical Center
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Covered Entity Details
Entity Name
Crozer Chester Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390180
Entity Address
One Medical Center Blvd
Upland, PA 19013-3995
Medicare Provider Number
390180
Participating Start Date
4/1/2012
Last Recertification Date
8/11/2015
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
RITE AID OF DELAWARE, INC.
Pharmacy Address
RITE AID #731
2096 NAAMANS ROAD
WILMINGTON, DE 19810
Pharmacy Comments
Contract Details
Approval Date
10/2/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
Philip J. Ryan, Senior VP & CFO
(610) 338-8228
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
10/2/2013
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