Contract Pharmacy Details

THRIFTY PAYLESS, INC.
FQHC638013 PIT RIVER HEALTH SERVICES

Covered Entity Details

Entity Name

PIT RIVER HEALTH SERVICES

Subdivision Name

Type

Tribal Contract/Compact with IHS (P.L. 93-638)

340B ID

FQHC638013

Entity Address

36977 PARK AVE.
BURNEY, CA 96013

Grant Number

Participating Start Date

7/1/2014

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #6353
432 NORTH MAIN STREET
ALTURAS, CA 96101

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

Sophia Rae Villarruel, Interim Authorizing Official
(530) 335-0332

Contract Pharmacy Representative

RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086

Signed By Date

7/17/2023

340B Drug Pricing Program Database