Contract Pharmacy Details

THRIFTY PAYLESS, INC.
DSH050348 UCI MEDICAL CENTER

Covered Entity Details

Entity Name

UCI MEDICAL CENTER

Subdivision Name

UNIVERSITY OF CALIFORNIA, IRVINE

Type

Disproportionate Share Hospital

340B ID

DSH050348

Entity Address

101 THE CITY DR. S RT32
ORANGE, CA 92868

Medicare Provider Number

050348

Participating Start Date

1/1/1998

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5755
630 EAST 1ST STREET
TUSTIN, CA 92780

Pharmacy Comments

Contract Details

Approval Date

7/11/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/28/2024
Pharmacy closed

Contacts

Covered Entity Signing Official

Howard Federoff, CEO & Vice Chancellor, Health Affairs
(949) 824-5926

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

7/11/2016

340B Drug Pricing Program Database