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THRIFTY PAYLESS, INC.
CHC28981-01 WESTERN SIERRA MEDICAL CLINIC INC
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Covered Entity Details
Entity Name
WESTERN SIERRA MEDICAL CLINIC INC
Subdivision Name
Sierra Family Medical Clinic Inc Tyler Foote
Type
HRSA-Funded Health Center
340B ID
CHC28981-01
Entity Address
15301 Tyler Foote Rd
Nevada City, CA 95959-9318
Grant Number
H80CS08234
Participating Start Date
4/1/2016
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6089
720 SUTTON WAY
GRASS VALLEY, CA 95945
Pharmacy Comments
Contract Details
Approval Date
4/22/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Steve Weber, CEO
(530) 292-3478 Ext: 230
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
4/22/2016
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