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RITE AID OF PENNSYLVANIA, LLC
FP158343 KEYSTONE RURAL HEALTH CONSORTIUM
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Covered Entity Details
Entity Name
KEYSTONE RURAL HEALTH CONSORTIUM
Subdivision Name
CAMERON COUNTY HEALTH CARE
Type
Family Planning (Title X only)
340B ID
FP158343
Entity Address
90 E. SECOND STREET
EMPORIUM, PA 15834
Grant Number
Participating Start Date
1/1/1998
Last Recertification Date
6/11/2015
Entity Termination Date
7/1/2015
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
1/2/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2015
Contacts
Covered Entity Signing Official
Kristie M. Bennardi, Administrator
(814) 486-1115
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/2/2014
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