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THRIFTY PAYLESS, INC.
DSH050335 Sonora Community Hospital DBA Adventist Health Sonora
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Covered Entity Details
Entity Name
Sonora Community Hospital DBA Adventist Health Sonora
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050335
Entity Address
1000 Greenley Road
Sonora, CA 95370
Medicare Provider Number
050335
Participating Start Date
4/1/2017
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6016
855 MONO WAY
SONORA, CA 95370
Pharmacy Comments
Contract Details
Approval Date
3/2/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrew Jahn, PRESIDENT/CEO
(209) 536-5012
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
3/2/2017
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