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THRIFTY PAYLESS, INC.
FQHCLA328 SAN JOAQUIN, COUNTY OF
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Covered Entity Details
Entity Name
SAN JOAQUIN, COUNTY OF
Subdivision Name
Primary Medicine Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA328
Entity Address
500 W. Hospital Rd
Suite C
French Camp, CA 95231-9693
Grant Number
LALCS00158
Participating Start Date
10/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5998
6455 PACIFIC AVENUE
STOCKTON, CA 95207
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
6/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Farhan Fadoo, Chief Executive Officer
(209) 953-3700
Contract Pharmacy Representative
Rite Aid
Lisa Foster, Manager-Pharmacy
(717) 214-2518
Signed By Date
4/14/2020
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