Contract Pharmacy Details

THRIFTY PAYLESS, INC.
FQHCLA397 Health Service Alliance

Covered Entity Details

Entity Name

Health Service Alliance

Subdivision Name

Chino Valley Community Health Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA397

Entity Address

13193 Central Ave STE 100
Chino, CA 91710

Grant Number

LALCS33333

Participating Start Date

10/1/2019

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5602
1841 EAST 4TH STREET
ONTARIO, CA 91764

Pharmacy Comments

Contract Details

Approval Date

4/15/2024

Contract Begin Date

7/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Jeff Cox, Chief Executive Officer
(909) 784-6117

Contract Pharmacy Representative

RiteAid
Mark Thorn, Manager, Pharmacy Replenishment Program
(734) 347-1086

Signed By Date

4/15/2024

340B Drug Pricing Program Database