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THRIFTY PAYLESS, INC.
DSH050568 MADERA COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MADERA COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050568
Entity Address
1250 E ALMOND AVENUE
MADERA, CA 93637
Medicare Provider Number
050568
Participating Start Date
4/1/2006
Last Recertification Date
8/25/2022
Entity Termination Date
10/1/2023
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5853
456 S MADERA AVENUE
KERMAN, CA 93630
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
MARK FOOTE, VP FINANCE/CFO
(559) 675-5505
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/15/2019
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