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THRIFTY PAYLESS, INC.
DSH050438 HUNTINGTON HOSPITAL
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Covered Entity Details
Entity Name
HUNTINGTON HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050438
Entity Address
100 W. California Blvd
Pasadena, CA 91105
Medicare Provider Number
050438
Participating Start Date
7/1/2019
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5531
914 FAIR OAKS AVENUE
SOUTH PASADENA, CA 91030
Pharmacy Comments
Contract Details
Approval Date
1/18/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven Mohr, Senior Vice President & Chief Financial Officer
(626) 397-5555
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
1/18/2020
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