Contract Pharmacy Details

THRIFTY PAYLESS, INC.
CH092536AU JWCH Institute, Inc.

Covered Entity Details

Entity Name

JWCH Institute, Inc.

Subdivision Name

Wesley Health Centers - MLK Recuperative Care Center

Type

HRSA-Funded Health Center

340B ID

CH092536AU

Entity Address

1670 E. 120th Street, West Support BLDG #14 FL 2
Los Angeles, CA 90059-3026

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

340B Drug Pricing Program Database