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THRIFTY PAYLESS, INC.
CH092536AS JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Student Health & Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH092536AS
Entity Address
855 N. Vermont Ave, Student Services Building STE 120
Los Angeles, CA 90029-3516
Grant Number
H80CS06673
Participating Start Date
10/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5429
500 SOUTH BROADWAY
LOS ANGELES, CA 90013
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Rite Aid
Jennifer Zorek, contact
(717) 975-5937
Signed By Date
7/14/2021
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