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THRIFTY PAYLESS, INC.
DSH380051 Salem Health
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Covered Entity Details
Entity Name
Salem Health
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH380051
Entity Address
890 Oak Street SE
Salem, OR 97301
Medicare Provider Number
380051
Participating Start Date
7/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5364
5452 RIVER ROAD NORTH
KEIZER, OR 97303
Pharmacy Comments
Contract Details
Approval Date
1/20/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James Parr, Chief Financial Officer
(503) 814-2841
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/20/2017
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