Contract Pharmacy Details

THRIFTY PAYLESS, INC.
FQHC638478 NOOKSACK INDIAN TRIBE OF WASHINGTON

Covered Entity Details

Entity Name

NOOKSACK INDIAN TRIBE OF WASHINGTON

Subdivision Name

NOOKSACK COMMUNITY HEALTH CLINIC

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638478

Entity Address

2510 Sulwhanon Drive
EVERSON, WA 98247

Grant Number

Participating Start Date

7/1/2002

Last Recertification Date

2/18/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5239
1225 EAST SUNSET DR STE 110
BELLINGHAM, WA 98226

Pharmacy Comments

Contract Details

Approval Date

11/15/2010

Contract Begin Date

12/1/2010

Carve-In Effective Date

Contract Comments

10/25/2012 CP Terminated in error 07/01/2012, reinstated

Contract Termination Date
Termination Reason

10/1/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

ROBERT KELLY, TRIBAL CHAIRMAN
(360) 592-5176

Contract Pharmacy Representative

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

Signed By Date

11/5/2010

340B Drug Pricing Program Database