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THRIFTY PAYLESS, INC.
CAH051304-00 JOHN C. FREMONT HEALTHCARE DISTRICT
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Covered Entity Details
Entity Name
JOHN C. FREMONT HEALTHCARE DISTRICT
Subdivision Name
A POLITICAL SUBDIVISION OF THE STATE OF CALIFORNIA
Type
Critical Access Hospital
340B ID
CAH051304-00
Entity Address
5189 HOSPITAL RD
MARIPOSA, CA 95338-0216
Medicare Provider Number
051304
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6443
4994 JOE HOWARD STREET
PO BOX 1159
MARIPOSA, CA 95338
Pharmacy Comments
Contract Details
Approval Date
1/18/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALAN MACPHEE, CHIEF EXECUTIVE OFFICER
(209) 966-3631 Ext: 290
Contract Pharmacy Representative
Rite Aid
Charlene Kaiser, VP, Managed Care Operations
(918) 645-6652
Signed By Date
1/18/2017
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