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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 #7853
901 S SAINT MARYS STREET
SAINT MARYS, PA 15857
Pharmacy Comments
Contract Details
Approval Date
4/5/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristie Bennardi, CEO
(814) 486-1115
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President Managed Care
(717) 975-5978
Signed By Date
4/5/2016
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