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THRIFTY PAYLESS, INC.
SCH050133-00 RIDEOUT MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
RIDEOUT MEMORIAL HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH050133-00
Entity Address
726 4TH STREET
MARYSVILLE, CA 95901
Medicare Provider Number
050133
Participating Start Date
4/1/2018
Last Recertification Date
Entity Termination Date
7/1/2018
Pharmacy Details
Pharmacy Name
THRIFTY PAYLESS, INC.
Pharmacy Address
RITE AID #6557
5075 OLIVEHURST AVENUE
OLIVEHURST, CA 95961
Pharmacy Comments
Contract Details
Approval Date
1/25/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Diane Moon, CFO
(530) 751-4260
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
1/16/2018
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