Contract Pharmacy Details

THRIFTY PAYLESS INC.
FQHCLA247C 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 - Del Paso Dental

Type

Health Center Program Look-Alike

340B ID

FQHCLA247C

Entity Address

2138 Del Paso Blvd
Sacramento, CA 95815-3002

Grant Number

LALCS00018

Participating Start Date

1/1/2014

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS INC.

Pharmacy Address

RITE AID #6264
8368 ELK GROVE FLORIN ROAD
SACRAMENTO, CA 95829

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

8/5/2021
OPA Terminated due to audit finding

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