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THRIFTY PAYLESS INC.
DSH050276G CONTRA COSTA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CONTRA COSTA REGIONAL MEDICAL CENTER
Subdivision Name
BRENTWOOD HEALTH CENTER
Type
Disproportionate Share Hospital
340B ID
DSH050276G
Entity Address
BRENTWOOD HEALTH CENTER
171 SAND CREEK ROAD, SUITE A
BRENTWOOD, CA 94513-2033
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 #5909
3353 DEER VALLEY ROAD
ANTIOCH, CA 94509
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
2/6/2019
Pharmacy closed
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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