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THRIFTY PAYLESS, INC.
CH091650 LONG VALLEY HEALTH CENTER, INC
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Covered Entity Details
Entity Name
LONG VALLEY HEALTH CENTER, INC
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH091650
Entity Address
50 BRANSCOMB ROAD
LAYTONVILLE, CA 95454
Grant Number
H80CS00524
Participating Start Date
1/1/2008
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6034
1730 SOUTH MAIN STREET
WILLITS, CA 95490
Pharmacy Comments
Contract Details
Approval Date
10/24/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/21/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Rodney O. Grainger, EXECUTIVE DIRECTOR
(707) 984-6131 Ext: 117
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
10/24/2014
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