Contract Pharmacy Details

RITE AID DRUG PALACE, INC.
FQHCLA334A NEW YORK CITY HEALTH AND HOSPITALS CORPORATION

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 DRUG PALACE, INC.

Pharmacy Address

RITE AID #1711
408 GRAND STREET
NEW YORK, NY 10002

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

8/24/2018
Business decision by covered entity and/or pharmacy

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

340B Drug Pricing Program Database