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THRIFTY PAYLESS, INC.
CAH381303-00 PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
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Covered Entity Details
Entity Name
PROVIDENCE HEALTH DBA PROVIDENCE SEASIDE HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381303-00
Entity Address
725 S. WAHANNA RD.
SEASIDE, OR 97138-7735
Medicare Provider Number
381303
Participating Start Date
7/1/2011
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5343
145 SOUTH HIGHWAY 101
WARRENTON, OR 97146
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/29/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
PAMELA J. Cooper, CHIEF FINANCIAL OFFICER
(503) 717-7296
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/17/2017
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