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THRIFTY PAYLESS, INC.
FQHCLA247B HEALTH AND LIFE ORGANIZATION INC.
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Covered Entity Details
Entity Name
HEALTH AND LIFE ORGANIZATION INC.
Subdivision Name
Sacramento Community Clinic-Assembly Court
Type
Health Center Program Look-Alike
340B ID
FQHCLA247B
Entity Address
5524 Assembly Ct.
Sacramento, CA 95823
Grant Number
LALCS00018
Participating Start Date
7/1/2012
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6432
7211 ELK GROVE BOULEVARD
ELK GROVE, CA 95758
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
4/17/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
JERRY T. BLIATOUT, CEO
(916) 428-3788 Ext: 4236
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/15/2019
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