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THRIFTY PAYLESS, INC.
DSH050276H CONTRA COSTA REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
CONTRA COSTA REGIONAL MEDICAL CENTER
Subdivision Name
CONTRA COSTA REGIONAL MEDICAL CENTER CLINIC
Type
Disproportionate Share Hospital
340B ID
DSH050276H
Entity Address
CONTRA COSTA REGIONAL MEDICAL CENTER CLINIC
2500 ALHAMBRA AVE
MARTINEZ, CA 94553-3156
Medicare Provider Number
050276
Outpatient Facility Provider Number
Participating Start Date
4/1/2007
Last Recertification Date
11/30/2017
Entity Termination Date
10/1/2018
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
10/1/2018
Covered Entity Terminated
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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