Contract Pharmacy Details

THRIFTY PAYLESS, INC.
RWI946091 Primary Care at Home, INC.

Covered Entity Details

Entity Name

Primary Care at Home, INC.

Subdivision Name

Type

Ryan White Part A

340B ID

RWI946091

Entity Address

400 - 29th Street
Suite 306
Oakland, CA 94609

Grant Number

H89HA00018

Participating Start Date

5/10/2021

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5952
1991 MOUNTAIN BOULEVARD
OAKLAND, CA 94611

Pharmacy Comments

Contract Details

Approval Date

7/15/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Anh T Nguyen, Board Secretary
(510) 320-2711

Contract Pharmacy Representative

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

Signed By Date

7/15/2024

340B Drug Pricing Program Database