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THRIFTY PAYLESS, INC.
DSH050382 EMANATE HEALTH MEDICAL CENTER
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Covered Entity Details
Entity Name
EMANATE HEALTH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050382
Entity Address
210 WEST SAN BERNARDINO ROAD
COVINA, CA 91723
Medicare Provider Number
050382
Participating Start Date
7/1/2017
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5591
18993 COLIMA ROAD
ROWLAND HEIGHTS, CA 91748
Pharmacy Comments
Contract Details
Approval Date
1/3/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2015
Contacts
Covered Entity Signing Official
Rajesh Sharma, CFO
(626) 938-7595
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/3/2014
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