340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
THRIFTY PAYLESS INC.
DSH050636 PALOMAR MEDICAL CENTER POWAY (PMC Poway)
Print
Covered Entity Details
Entity Name
PALOMAR MEDICAL CENTER POWAY (PMC Poway)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050636
Entity Address
15615 POMERADO RD
POWAY, CA 92064-2405
Medicare Provider Number
050636
Participating Start Date
7/1/2015
Last Recertification Date
9/9/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS INC.
Pharmacy Address
RITE AID #5637
12666 POWAY ROAD
POWAY, CA 92064
Pharmacy Comments
Contract Details
Approval Date
7/27/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/2/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
Diane Lynette Hansen, President & CEO
(760) 740-6395
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
7/27/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session