Contract Pharmacy Details

RITE AID OF NEW YORK, INC.
RRC330094-00 Columbia Memorial Hospital

Covered Entity Details

Entity Name

Columbia Memorial Hospital

Subdivision Name

Type

Rural Referral Center

340B ID

RRC330094-00

Entity Address

71 Prospect Aveune
Hudson, NY 12534

Medicare Provider Number

330094

Participating Start Date

10/1/2013

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

RITE AID OF NEW YORK, INC.

Pharmacy Address

RITE AID #161
226 WEST BRIDGE STREET
CATSKILL, NY 12414

Pharmacy Comments

Contract Details

Approval Date

1/14/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/6/2018
Ownership change

Contacts

Covered Entity Signing Official

Vincent J. Dingman III, Chief Financial Officer
(518) 828-7601 Ext: 8249

Contract Pharmacy Representative

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

Signed By Date

1/14/2014

340B Drug Pricing Program Database