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THRIFTY PAYLESS, INC.
CAH051321-00 NorCal HealthConnect LLC- DBA Healdsburg Hospital
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Covered Entity Details
Entity Name
NorCal HealthConnect LLC- DBA Healdsburg Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH051321-00
Entity Address
1375 UNIVERSITY AVENUE
HEALDSBURG, CA 95448
Medicare Provider Number
051321
Participating Start Date
8/23/2010
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6023
1551 FARMERS LANE
SANTA ROSA, CA 95405
Pharmacy Comments
Contract Details
Approval Date
11/14/2017
Contract Begin Date
11/14/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/26/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Berta Beadel Kaemmerling, Chief Nursing Officer
(707) 431-6327
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
11/14/2017
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