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THRIFTY PAYLESS, INC.
CAH051301-00 Adventist Health Medical Center Tehachapi
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Covered Entity Details
Entity Name
Adventist Health Medical Center Tehachapi
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051301-00
Entity Address
1100 Magellan DR
Tehachapi, CA 93561
Medicare Provider Number
051301
Participating Start Date
10/1/2012
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5837
9482 CALIFORNIA CITY BOULEVARD
CALIFORNIA CITY, CA 93505
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steven G Chen, CHIEF FINANCIAL OFFICER
(661) 869-6183
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/17/2017
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