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THRIFTY PAYLESS, INC.
DSH050590 METHODIST HOSPITAL OF SACRAMENTO
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Covered Entity Details
Entity Name
METHODIST HOSPITAL OF SACRAMENTO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050590
Entity Address
7500 HOSPITAL DRIVE
SACRAMENTO, CA 95823
Medicare Provider Number
050590
Participating Start Date
4/1/2005
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6073
5712 FOLSOM BOULEVARD
SACRAMENTO, CA 95819
Pharmacy Comments
Contract Details
Approval Date
7/21/2020
Contract Begin Date
10/1/2020
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
Eric Hodes, CMO
(916) 423-6023
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/21/2020
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