Contract Pharmacy Details

THRIFTY PAYLESS INC.
DSH060107 NATIONAL JEWISH MEDICAL AND RESEARCH CENTER

Covered Entity Details

Entity Name

NATIONAL JEWISH MEDICAL AND RESEARCH CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH060107

Entity Address

1400 JACKSON STREET
DENVER, CO 80206

Medicare Provider Number

060107

Participating Start Date

10/1/2004

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS INC.

Pharmacy Address

RITE AID #6166
2870 SOUTH COLORADO BLVD
DENVER, CO 80222

Pharmacy Comments

Contract Details

Approval Date

10/18/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

11/16/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

CHRISTINE FORKNER, CFO
(303) 398-1004

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

10/18/2016

340B Drug Pricing Program Database