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THRIFTY PAYLESS, INC.
CAH501304-01 Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
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Covered Entity Details
Entity Name
Grays Harbor County Public Hospital District No. 1 DBA Summit Pacific Medical Center
Subdivision Name
Summit Pacific Urgent Care Clinic
Type
Critical Access Hospital
340B ID
CAH501304-01
Entity Address
600 E MAIN ST
ELMA, WA 98541-9353
Medicare Provider Number
501304
Outpatient Facility Provider Number
508560
Participating Start Date
1/1/2015
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #5282
301 EAST WISHKAH STREET
ABERDEEN, WA 98520
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Will S. Callicoat, CFO
(360) 346-2246
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/16/2017
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