Contract Pharmacy Details

RITE AID OF PENNSYLVANIA, LLC
DSH390081 Delaware County Memorial Hospital

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 #2442
950 EAST BALTIMORE PIKE
YEADON, PA 19050

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

340B Drug Pricing Program Database