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THRIFTY PAYLESS, INC.
CHC22686-01 BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Subdivision Name
2520 E Palmdale Blvd Palmdale CA 93550
Type
HRSA-Funded Health Center
340B ID
CHC22686-01
Entity Address
2520 E Palmdale Blvd
Suite A
Palmdale, CA 93550-4914
Grant Number
H80CS22686
Participating Start Date
10/1/2020
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID # 5844
37950 47TH ST E
PALMDALE, CA 93552-3271
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mary Cummings, CEO
(661) 579-9317
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
10/15/2020
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