Contract Pharmacy Details

THRIFTY PAYLESS, INC.
CHC26613-00 ANTELOPE VALLEY COMMUNITY CLINIC

Covered Entity Details

Entity Name

ANTELOPE VALLEY COMMUNITY CLINIC

Subdivision Name

Antelope Valley Community Clinic - Health and Wellness Center

Type

HRSA-Funded Health Center

340B ID

CHC26613-00

Entity Address

45104 10th St W
Lancaster, CA 93534-2310

Grant Number

H80CS26613

Participating Start Date

4/1/2014

Last Recertification Date

2/1/2019

Entity Termination Date

10/1/2019

Pharmacy Details

Pharmacy Name

THRIFTY PAYLESS, INC.

Pharmacy Address

RITE AID #5840
1356 WEST AVENUE J
LANCASTER, CA 93534

Pharmacy Comments

Contract Details

Approval Date

4/16/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2019
Covered Entity Terminated

Contacts

Covered Entity Signing Official

James A. Cook, CEO
(661) 942-2391

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

4/16/2014

340B Drug Pricing Program Database