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THRIFTY PAYLESS, INC.
DSH050045 EL CENTRO REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
EL CENTRO REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050045
Entity Address
1415 ROSS AVENUE
EL CENTRO, CA 92243
Medicare Provider Number
050045
Participating Start Date
10/1/2006
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6515
211 WEST BIRCH STREET
CALEXICO, CA 92231
Pharmacy Comments
Contract Details
Approval Date
1/14/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Momberg, CFO
(858) 208-7724
Contract Pharmacy Representative
Rite Aid
Mark J Thorn, Director/CPA 340B program
(734) 347-1086
Signed By Date
1/14/2025
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