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THRIFTY PAYLESS, INC.
DSH050009 ST Joseph Health Northern California LLC-DBA Queen of the Valley Medical Center
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Covered Entity Details
Entity Name
ST Joseph Health Northern California LLC-DBA Queen of the Valley Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050009
Entity Address
1000 TRANCAS STREET
NAPA, CA 94558
Medicare Provider Number
050009
Participating Start Date
4/1/2016
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5928
1203 W IMOLA AVE
NAPA, CA 94559-4725
Pharmacy Comments
Contract Details
Approval Date
1/25/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/29/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patti Pilgrim, Regional CFO
(707) 525-5323
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
1/25/2021
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