Contract Pharmacy Details

THRIFTY PAYLESS, INC.
FQHCLA247D HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)

Covered Entity Details

Entity Name

HEALTH AND LIFE ORGANIZATION, INC. (H.A.L.O.)

Subdivision Name

Sacramento Community Clinic - Explorer Drive

Type

Health Center Program Look-Alike

340B ID

FQHCLA247D

Entity Address

3030 Explorer Drive
Sacramento, CA 95827-2728

Grant Number

LALCS00018

Participating Start Date

7/1/2016

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #6054
6639 WATT AVENUE
NORTH HIGHLANDS, CA 95660

Pharmacy Comments

Contract Details

Approval Date

4/15/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

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

340B Drug Pricing Program Database