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THRIFTY PAYLESS, INC.
DSH500119 VALLEY HOSPITAL & MEDICAL CENTER
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Covered Entity Details
Entity Name
VALLEY HOSPITAL & MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500119
Entity Address
12606 E MISSION Ave
SPOKANE Valley, WA 99216
Medicare Provider Number
500119
Participating Start Date
10/1/2019
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5309
1443 NORTH ARGONNE ROAD
SPOKANE VALLEY, WA 99212
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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