Contract Pharmacy Details

THRIFTY PAYLESS, INC.
CHC24145-00 WALLACE MEDICAL CONCERN, THE

Covered Entity Details

Entity Name

WALLACE MEDICAL CONCERN, THE

Subdivision Name

Wallace Rockwood Clinic

Type

HRSA-Funded Health Center

340B ID

CHC24145-00

Entity Address

18633 SE Stark St.
Suite 401
Portland, OR 97233-5468

Grant Number

H80CS24145

Participating Start Date

4/1/2014

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5357
514 NE 181ST AVENUE
PORTLAND, OR 97230

Pharmacy Comments

Contract Details

Approval Date

4/8/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lisa Cline, Chief Executive Officer
(503) 907-0591

Contract Pharmacy Representative

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

Signed By Date

4/8/2021

340B Drug Pricing Program Database