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THRIFTY PAYLESS, INC.
DSH050454 UCSF-MEDICAL CENTER
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Covered Entity Details
Entity Name
UCSF-MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050454
Entity Address
505 PARNASSUS AVE.
SAN FRANCISCO, CA 94143
Medicare Provider Number
050454
Participating Start Date
7/1/1993
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6021
1793 MARLOW ROAD
SANTA ROSA, CA 95401
Pharmacy Comments
Contract Details
Approval Date
7/1/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARK LARET, CEO
(415) 353-2733
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/1/2016
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