Contract Pharmacy Details

RITE AID OF OHIO, INC.
CHC30718-02 SIGNATURE HEALTH, INC.

Covered Entity Details

Entity Name

SIGNATURE HEALTH, INC.

Subdivision Name

Signature Health, Inc. Willoughby Clinic

Type

HRSA-Funded Health Center

340B ID

CHC30718-02

Entity Address

38882 Mentor Avenue
Willoughby, OH 44094-7875

Grant Number

H80CS30718

Participating Start Date

4/1/2017

Last Recertification Date

2/11/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

RITE AID OF OHIO, INC.

Pharmacy Address

RITE AID #3195
180 NORTH STATE STREET
PAINESVILLE, OH 44077

Pharmacy Comments

Contract Details

Approval Date

1/15/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/14/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jonathan Albert Lee, CEO
(440) 953-9999 Ext: 705133

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

1/15/2018

340B Drug Pricing Program Database