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THRIFTY PAYLESS, INC.
DSH050084 ST JOSEPH'S MEDICAL CENTER
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Covered Entity Details
Entity Name
ST JOSEPH'S MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050084
Entity Address
1800 N CALIFORNIA STREET
STOCKTON, CA 95204
Medicare Provider Number
050084
Participating Start Date
1/1/2005
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5996
1050 NORTH WILSON WAY
STOCKTON, CA 95205
Pharmacy Comments
Contract Details
Approval Date
4/20/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Donald J Wiley, President and CEO
(209) 467-6384
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
4/20/2020
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