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THRIFTY PAYLESS, INC.
DSH050107 MARIAN MEDICAL CENTER
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Covered Entity Details
Entity Name
MARIAN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050107
Entity Address
1400 E CHURCH ST
SANTA MARIA, CA 93454
Medicare Provider Number
050107
Participating Start Date
1/1/2005
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5836
2405 SOUTH BROADWAY
SANTA MARIA, CA 93454
Pharmacy Comments
Contract Details
Approval Date
1/17/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Matt Richardson, VP/CFO Service Area CFO
(805) 739-3108
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/17/2020
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