Contract Pharmacy Details

THRIFT DRUG, INC.
DSH210019 TIDALHEALTH PENINSULA REGIONAL INC

Covered Entity Details

Entity Name

TIDALHEALTH PENINSULA REGIONAL INC

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH210019

Entity Address

100 EAST CARROLL STREET
SALISBURY, MD 21801

Medicare Provider Number

210019

Participating Start Date

3/15/2022

Last Recertification Date

8/15/2024

Pharmacy Details

Pharmacy Name

THRIFT DRUG, INC.

Pharmacy Address

RITE AID #11219
1316 MOUNT HERMON ROAD.
SALISBURY, MD 21804

Pharmacy Comments

Contract Details

Approval Date

7/2/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/31/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Bruce Ritchie, CFO
(410) 543-7298

Contract Pharmacy Representative

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

Signed By Date

7/2/2018

340B Drug Pricing Program Database