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THRIFTY PAYLESS, INC.
SCH380001-00 Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge
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Covered Entity Details
Entity Name
Mid-Columbia Medical Center DBA Adventist Health Columbia Gorge
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH380001-00
Entity Address
1700 E 19TH STREET
THE DALLES, OR 97058-3398
Medicare Provider Number
380001
Participating Start Date
9/28/2010
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5328
2049 WEST CASCADE AVENUE
HOOD RIVER, OR 97031
Pharmacy Comments
Contract Details
Approval Date
7/1/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DENNIS KNOX, CEO
(541) 296-7272
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/1/2019
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