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THRIFTY PAYLESS, INC.
FQHC638012F Northern Valley Indian Health
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Covered Entity Details
Entity Name
Northern Valley Indian Health
Subdivision Name
Gibson Rd
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638012F
Entity Address
1280 E Gibson Rd
Woodland, CA 95776
Grant Number
Participating Start Date
10/1/2021
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6087
650 MANGROVE AVENUE
CHICO, CA 95926
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Inder Wadhwa, CEO
(530) 896-9409
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
7/17/2023
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