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THRIFTY PAYLESS, INC.
DSH050444 MERCY MEDICAL CENTER MERCED
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Covered Entity Details
Entity Name
MERCY MEDICAL CENTER MERCED
Subdivision Name
COMMUNITY CAMPUS
Type
Disproportionate Share Hospital
340B ID
DSH050444
Entity Address
333 MERCY AVE
MERCED, CA 95340
Medicare Provider Number
050444
Participating Start Date
7/1/1994
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5855
1317 EAST PACHECO BOULEVARD
LOS BANOS, CA 93635
Pharmacy Comments
Contract Details
Approval Date
4/6/2020
Contract Begin Date
7/1/2020
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
Michael Strasser, CFO
(209) 564-5003
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
4/6/2020
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