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THRIFTY PAYLESS, INC.
DSH500033 SAMARITAN HOSPITAL
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Covered Entity Details
Entity Name
SAMARITAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500033
Entity Address
801 E WHEELER ROAD
MOSES LAKE, WA 98837
Medicare Provider Number
500033
Participating Start Date
1/1/2009
Last Recertification Date
8/20/2019
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5293
500 SOUTH PIONEER WAY
MOSES LAKE, WA 98837
Pharmacy Comments
Contract Details
Approval Date
2/19/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Thomas J. Legel, CFO
(509) 793-9710
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/14/2013
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