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THRIFTY PAYLESS, INC.
CAH381320-00 Columbia Lutheran Charities DBA Columbia Memorial Hospital
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Covered Entity Details
Entity Name
Columbia Lutheran Charities DBA Columbia Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381320-00
Entity Address
2111 Exchange Street
Astoria, OR 97103-3329
Medicare Provider Number
381320
Participating Start Date
10/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5342
313 SOUTH ROOSEVELT DRIVE
SEASIDE, OR 97138
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Zachary Schmitt, Chief Financial Officer
(503) 338-7505
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/12/2018
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