Contract Pharmacy Details

THRIFTY PAYLESS, INC.
CH092536AN JWCH Institute, Inc.

Covered Entity Details

Entity Name

JWCH Institute, Inc.

Subdivision Name

Wesley Health Centers- Palmdale Central

Type

HRSA-Funded Health Center

340B ID

CH092536AN

Entity Address

2151 E Palmdale Blvd
Palmdale, CA 93550-4037

Grant Number

H80CS06673

Participating Start Date

5/2/2019

Last Recertification Date

2/19/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #6396
2419 EAST AVENUE S
PALMDALE, CA 93550

Pharmacy Comments

Contract Details

Approval Date

5/10/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

5/10/2019

340B Drug Pricing Program Database