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THRIFTY PAYLESS, INC.
DSH500041 PEACEHEALTH ST. JOHN MEDICAL CENTER
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Covered Entity Details
Entity Name
PEACEHEALTH ST. JOHN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500041
Entity Address
1615 DELAWARE ST
LONGVIEW, WA 98632
Medicare Provider Number
500041
Participating Start Date
7/1/2004
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5287
230 KELSO DRIVE
KELSO, WA 98626
Pharmacy Comments
Contract Details
Approval Date
1/8/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/8/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sean Gregory, Chief Executive
(360) 514-2082
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
1/8/2021
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