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THRIFTY PAYLESS, INC.
DSH050133 RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
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Covered Entity Details
Entity Name
RIDEOUT MEMORIAL HOSPITAL DBA Adventist Health and Rideout
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050133
Entity Address
726 4TH STREET
MARYSVILLE, CA 95901
Medicare Provider Number
050133
Participating Start Date
7/2/2018
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6557
5075 OLIVEHURST AVENUE
OLIVEHURST, CA 95961
Pharmacy Comments
Contract Details
Approval Date
7/4/2018
Contract Begin Date
7/2/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ed Gonzalez, CFO
(530) 751-4010
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/4/2018
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