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THRIFTY PAYLESS, INC.
DSH050115 PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)
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Covered Entity Details
Entity Name
PALOMAR MEDICAL CENTER ESCONDIDO (PMC Escondido)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050115
Entity Address
2185 Citracado Parkway
Escondido, CA 92029
Medicare Provider Number
050115
Participating Start Date
4/1/2006
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6225
1665 ALPINE BOULEVARD
ALPINE, CA 91901
Pharmacy Comments
Contract Details
Approval Date
7/14/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/14/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diane Lynette Hansen, President & CEO
(760) 740-6395
Contract Pharmacy Representative
PDS I Michigan, Inc
Allison Farrell, Senior Vice President
(717) 214-8834
Signed By Date
7/14/2017
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