340B Drug Pricing Program Database
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THRIFTY PAYLESS, INC.
CAH381323-00 MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
MID-VALLEY HEALTHCARE, INC. DBA SAMARITAN LEBANON COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381323-00
Entity Address
525 N. SANTIAM HWY
LEBANON, OR 97355
Medicare Provider Number
381323
Participating Start Date
8/4/2010
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5365
1235 WAVERLY DRIVE SE
ALBANY, OR 97322
Pharmacy Comments
Contract Details
Approval Date
2/15/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/8/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Smith, Chief Financial Officer
(541) 768-5390
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/11/2013
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