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RITE AID OF NEW YORK, INC.
FQHCLA334A NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
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Covered Entity Details
Entity Name
NEW YORK CITY HEALTH AND HOSPITALS CORPORATION
Subdivision Name
Sydenham Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA334A
Entity Address
264 W 118th St
New York, NY 10026-1736
Grant Number
LALCS00169
Participating Start Date
7/1/2015
Last Recertification Date
2/10/2019
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
RITE AID OF NEW YORK, INC.
Pharmacy Address
RITE AID #7760
2170 FREDERICK DOUGLASS BLVD
NEW YORK, NY 10026
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Albertson, Vice President
(212) 748-2256
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/12/2017
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