Contract Pharmacy Details

THRIFTY PAYLESS, INC.
FQHC638398 JAMESTOWN S'KLALLAM TRIBE

Covered Entity Details

Entity Name

JAMESTOWN S'KLALLAM TRIBE

Subdivision Name

Jamestown Family Health Clinic

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638398

Entity Address

808 N. 5th Avenue
SEQUIM, WA 98382

Grant Number

Participating Start Date

1/1/2001

Last Recertification Date

3/5/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5257
621 SOUTH LINCOLN ST.
PORT ANGELES, WA 98362

Pharmacy Comments

Contract Details

Approval Date

4/4/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Brent D. Simcosky, Director of Health Services
(360) 582-4870

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

4/4/2014

340B Drug Pricing Program Database