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THRIFTY PAYLESS, INC.
CAH381315-00 ST. ALPHONSUS MEDICAL CENTER BAKER CITY
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Covered Entity Details
Entity Name
ST. ALPHONSUS MEDICAL CENTER BAKER CITY
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH381315-00
Entity Address
3325 POCAHONTAS ROAD
BAKER CITY, OR 97814
Medicare Provider Number
381315
Participating Start Date
7/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5396
1217 CAMPBELL STREET
BAKER CITY, OR 97814
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
RAY GIBBONS, CEO
(541) 523-2965
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/15/2016
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