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THRIFTY PAYLESS, INC.
FQHC638005 GREENVILLE RANCHERIA TRIBAL HEALTH
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Covered Entity Details
Entity Name
GREENVILLE RANCHERIA TRIBAL HEALTH
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638005
Entity Address
410 MAIN STREET
GREENVILLE, CA 95947
Grant Number
Participating Start Date
7/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6188
640 EDITH AVENUE
CORNING, CA 96021
Pharmacy Comments
Contract Details
Approval Date
4/20/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lucretia Fletcher, Tribal Administrator
(530) 528-8600 Ext: 200
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
4/20/2022
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