Contract Pharmacy Details

THRIFTY PAYLESS, INC.
DSH500030 ST. JOSEPH MEDICAL CENTER

Covered Entity Details

Entity Name

ST. JOSEPH MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500030

Entity Address

2901 SQUALICUM PARKWAY
BELLINGHAM, WA 98225-1851

Medicare Provider Number

500030

Participating Start Date

10/1/2018

Last Recertification Date

8/18/2024

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5242
8090 GUIDE MERIDIAN ROAD.
LYNDEN, WA 98264

Pharmacy Comments

Contract Details

Approval Date

1/10/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/10/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Krista N Touros, CFO
(360) 788-6754 Ext: 6754

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968

Signed By Date

1/10/2021

340B Drug Pricing Program Database