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THRIFTY PAYLESS, INC.
SCH050335-00 ADVENTIST HEALTH SONORA
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Covered Entity Details
Entity Name
ADVENTIST HEALTH SONORA
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH050335-00
Entity Address
1000 GREENLEY ROAD
SONORA, CA 95370
Medicare Provider Number
050335
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6016
855 MONO WAY
SONORA, CA 95370
Pharmacy Comments
Contract Details
Approval Date
10/18/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Andrew Jahn, PRESIDENT/CEO
(209) 536-5012
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/18/2016
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