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THRIFTY PAYLESS, INC.
DSH050122 DAMERON HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
DAMERON HOSPITAL ASSOCIATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050122
Entity Address
525 WEST ACACIA STREET
STOCKTON, CA 95203
Medicare Provider Number
050122
Participating Start Date
10/1/2006
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5998
6455 PACIFIC AVENUE
STOCKTON, CA 95207
Pharmacy Comments
Contract Details
Approval Date
8/24/2022
Contract Begin Date
8/29/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timothy Karagounis, Operations Executive
(209) 461-7596 Ext: 2092007800
Contract Pharmacy Representative
Rite Aid
David Bell, Rep
(717) 761-2633 Ext: 5311
Signed By Date
8/24/2022
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