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THRIFTY PAYLESS, INC.
DSH500015 MULTICARE AUBURN MEDICAL CENTER
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Covered Entity Details
Entity Name
MULTICARE AUBURN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500015
Entity Address
202 NORTH DIVISION STREET
AUBURN, WA 98001
Medicare Provider Number
500015
Participating Start Date
1/1/2015
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5190
10407 SE 256TH STREET
KENT, WA 98030
Pharmacy Comments
Contract Details
Approval Date
4/17/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Florence Chang, President
(253) 403-7355
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/17/2020
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