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THRIFTY PAYLESS, INC.
FQHCLA311 Greater Fresno Health Organization
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Covered Entity Details
Entity Name
Greater Fresno Health Organization
Subdivision Name
Kings Winery Medical Clinic
Type
Health Center Program Look-Alike
340B ID
FQHCLA311
Entity Address
4929 E Cesar Chavez Blvd
Fresno, CA 93727-3812
Grant Number
LALCS00041
Participating Start Date
10/1/2018
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6289
4593 NORTH CEDAR AVENUE
FRESNO, CA 93726
Pharmacy Comments
Contract Details
Approval Date
4/8/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BLA MOUANOUTOUA, CEO
(559) 255-6476 Ext: 4290
Contract Pharmacy Representative
Rite Aid
Owen McMahon, Group Vice President-Enterprise pharmaceutical Purchasing
(717) 732-0711
Signed By Date
4/8/2024
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