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THRIFTY PAYLESS, INC.
DSH500058 Kadlec Regional Medical Center
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Covered Entity Details
Entity Name
Kadlec Regional Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500058
Entity Address
888 SWIFT BOULEVARD
RICHLAND, WA 99352
Medicare Provider Number
500058
Participating Start Date
7/1/2007
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5314
1308 NORTH 20TH AVENUE
PASCO, WA 99301
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Spencer Dwayne Harris, CFO
(509) 942-2708
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/15/2020
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