340B Drug Pricing Program Database

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #4722
887 STATE ROUTE 11
PO BOX 576
CHAMPLAIN, NY 12919

Pharmacy Comments

Approval Date

9/26/2012

Contract Begin Date

10/1/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/8/2018
Pharmacy closed

Covered Entity Signing Official

George Purdue, Chief Administrative Officer
(518) 761-0300 Ext: 31114

Contract Pharmacy Representative

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

Signed By Date

9/11/2012