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RITE AID OF PENNSYLVANIA, LLC
DSH390081 Delaware County Memorial Hospital
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Covered Entity Details
Entity Name
Delaware County Memorial Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390081
Entity Address
501 N. Lansdowne Avenue
Drexel Hill, PA 19026-1186
Medicare Provider Number
390081
Participating Start Date
7/1/2012
Last Recertification Date
8/11/2015
Entity Termination Date
10/1/2016
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #679
123 SOUTH 69TH STREET
UPPER DARBY, PA 19082
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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