Contract Pharmacy Details

THRIFTY PAYLESS, INC.
DSH380052 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC.

Covered Entity Details

Entity Name

SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC.

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH380052

Entity Address

351 SW 9TH STREET
ONTARIO, OR 97914

Medicare Provider Number

380052

Participating Start Date

7/1/2004

Last Recertification Date

8/30/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5400
728 SOUTH WEST 4TH AVENUE
ONTARIO, OR 97914

Pharmacy Comments

Contract Details

Approval Date

7/19/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kenneth Fry, VP Finance
(208) 367-3445

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President Managed Care
(717) 975-5978

Signed By Date

7/19/2016

340B Drug Pricing Program Database