Contract Pharmacy Details

THRIFT DRUG, INC.
DSH390086 DUBOIS REGIONAL MEDICAL CENTER

Covered Entity Details

Entity Name

DUBOIS REGIONAL MEDICAL CENTER

Subdivision Name

dba Penn Highlands DuBois

Type

Disproportionate Share Hospital

340B ID

DSH390086

Entity Address

100 HOSPITAL AVENUE
DUBOIS, PA 15801

Medicare Provider Number

390086

Participating Start Date

7/1/2004

Last Recertification Date

8/12/2024

Pharmacy Details

Pharmacy Name

THRIFT DRUG, INC.

Pharmacy Address

RITE AID #10975
201 WEST MAHONING STREET
PUNXSUTAWNEY, PA 15767

Pharmacy Comments

Contract Details

Approval Date

10/16/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Brian Kline, CFO
(814) 375-6377

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

10/16/2013

340B Drug Pricing Program Database