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THRIFTY PAYLESS, INC.
DSH500077 PROVIDENCE HEALTH & SERVICES-WASHINGTON
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH & SERVICES-WASHINGTON
Subdivision Name
PROVIDENCE HOLY FAMILY HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH500077
Entity Address
5633 NORTH LIDGERWOOD STREET
SPOKANE, WA 99208
Medicare Provider Number
500077
Participating Start Date
7/1/2010
Last Recertification Date
9/11/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5311
12420 NORTH DIVISION STREET
SPOKANE, WA 99218
Pharmacy Comments
Contract Details
Approval Date
7/11/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/30/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Helen Andrus, CFO
(509) 474-3307
Contract Pharmacy Representative
Rite Aid
Chris Hall, Senior Vice President
(717) 214-8834
Signed By Date
7/11/2013
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