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THRIFTY PAYLESS, INC.
DSH050239 GLENDALE ADVENTIST MEDICAL CENTER
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Covered Entity Details
Entity Name
GLENDALE ADVENTIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050239
Entity Address
1509 WILSON TERRACE
GLENDALE, CA 91206
Medicare Provider Number
050239
Participating Start Date
4/1/2005
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5448
4044 EAGLE ROCK BOULEVARD
LOS ANGELES, CA 90065
Pharmacy Comments
Contract Details
Approval Date
10/28/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JON GIESE, VP of FINANCE, CFO
(818) 409-8289
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/28/2016
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