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THRIFTY PAYLESS, INC.
DSH050276C CONTRA COSTA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CONTRA COSTA REGIONAL MEDICAL CENTER
Subdivision Name
CONCORD HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050276C
Entity Address
CONCORD HEALTH CENTER
3052 WILLOW PASS ROAD
CONCORD, CA 94519-7600
Medicare Provider Number
050276
Outpatient Facility Provider Number
Participating Start Date
4/1/2007
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6356
4100 LONE TREE WAY
ANTIOCH, CA 94531
Pharmacy Comments
Contract Details
Approval Date
6/1/2009
Contract Begin Date
6/1/2009
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/14/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/30/2009
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