Contract Pharmacy Details

THRIFTY PAYLESS, INC.
DSH050276D CONTRA COSTA REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

CONTRA COSTA REGIONAL MEDICAL CENTER

Subdivision Name

NORTH RICHMOND CENTER FOR HEALTH

Type

Disproportionate Share Hospital

340B ID

DSH050276D

Entity Address

NORTH RICHMOND CENTER FOR HEALTH
1501 FRED JACKSON WAY (FORMERLY 3RD ST.)
NORTH RICHMOND, CA 94801-1516

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 #5923
1560 SYCAMORE AVENUE
HERCULES, CA 94547

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

340B Drug Pricing Program Database