Contract Pharmacy Details

THRIFTY PAYLESS, INC.
CHC24115-00 SABAN FREE CLINIC, THE

Covered Entity Details

Entity Name

SABAN FREE CLINIC, THE

Subdivision Name

Beverly Health Center

Type

HRSA-Funded Health Center

340B ID

CHC24115-00

Entity Address

8405 Beverly Blvd.
Los Angeles, CA 90048-3401

Grant Number

H80CS24115

Participating Start Date

10/1/2012

Last Recertification Date

2/10/2025

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5425
334 SOUTH VERMONT AVENUE
LOS ANGELES, CA 90020

Pharmacy Comments

Contract Details

Approval Date

7/18/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/30/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Julie Hudman, CEO
(323) 330-1660

Contract Pharmacy Representative

Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

7/18/2017

340B Drug Pricing Program Database