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THRIFTY PAYLESS, INC.
DSH050342 PIONEERS MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
PIONEERS MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050342
Entity Address
207 WEST LEGION ROAD
BRAWLEY, CA 92227
Medicare Provider Number
050342
Participating Start Date
9/2/2008
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5674
405 WEST MAIN STREET
BRAWLEY, CA 92227
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Carly Loper, Chief Financial Officer
(760) 351-3594
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President, Managed Care
(717) 975-5968
Signed By Date
4/15/2021
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