Contract Pharmacy Details

THRIFTY PAYLESS, INC.
CHC22686-01 BARTZ-ALTADONNA COMMUNITY HEALTH CENTER

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 #6396
2419 EAST AVENUE S
PALMDALE, CA 93550

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

1/31/2025
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

340B Drug Pricing Program Database