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THRIFTY PAYLESS, INC.
DSH050036 BAKERSFIELD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
BAKERSFIELD MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050036
Entity Address
420 34TH STREET
BAKERSFIELD, CA 93301
Medicare Provider Number
050036
Participating Start Date
9/9/2005
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5797
5530 LAKE ISABELLA BOULEVARD
PO BOX 3740
LAKE ISABELLA, CA 93240
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
Ken Keller, President
(661) 541-0001
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/17/2020
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