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RITE AID OF PENNSYLVANIA, LLC
CH03230D KEYSTONE RURAL HEALTH CONSORTIA INC
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Covered Entity Details
Entity Name
KEYSTONE RURAL HEALTH CONSORTIA INC
Subdivision Name
CAMERON COUNTY DENTAL CTR
Type
HRSA-Funded Health Center
340B ID
CH03230D
Entity Address
90 E 2ND ST
EMPORIUM, PA 15834-1302
Grant Number
H80CS00688
Participating Start Date
10/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
RITE AID OF PENNSYLVANIA, LLC
Pharmacy Address
RITE AID #7850
620 E ALLEGHENY AVENUE
EMPORIUM, PA 15834
Pharmacy Comments
Contract Details
Approval Date
10/10/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristie Bennardi, Administrator
(814) 598-5513
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
10/10/2014
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