Contract Pharmacy Details

THRIFTY PAYLESS, INC.
CHC24112-02 McCloud Healthcare Clinic Inc

Covered Entity Details

Entity Name

McCloud Healthcare Clinic Inc

Subdivision Name

Shasta Cascade Health Centers - Mt. Shasta

Type

HRSA-Funded Health Center

340B ID

CHC24112-02

Entity Address

824 Pine St
Mount Shasta, CA 96067-2137

Grant Number

H80CS24112

Participating Start Date

7/1/2019

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #6103
310 WEST LAKE STREET
MOUNT SHASTA, CA 96067

Pharmacy Comments

Contract Details

Approval Date

4/16/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/14/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

James Sumner Proffitt, CEO
(530) 964-2389

Contract Pharmacy Representative

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

Signed By Date

4/12/2019

340B Drug Pricing Program Database