Covered Entity Details

CH013970 RICHFORD HEALTH CENTER, INC. (Active) - information as of 4/25/2025 6:36:15 PM

Main Details

Name

RICHFORD HEALTH CENTER, INC.

Subdivision Name

Richford Health Center

Type

HRSA-Funded Health Center

Site ID

BPS-H80-004635

340B ID

CH013970

Grant Number

H80CS00261

Additional Details

Current Program Status

Active

Registration Date

1/1/2003

Participating Start Date

1/1/2003

Participating Approval Date

4/2/2004

Last Recertification Date

2/12/2025

Contacts

Authorizing Official

Richford Health Center, Inc.
KATHY J BENOIT, Executive Director
(802) 255-5562 Ext: 562

Primary Contact

Richford Health Center, Inc.
Darlene Gregoire, Executive Assistant
(802) 255-5563 Ext: 563

Addresses

Street Address

44 Main Street
Richford, VT 05476-1153

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
3/8/12 - As of 1/1/2012 Carve-in Medicaid for 340B. 10/6/10 CHANGE MEDICAID # (WAS 1012328); 3/4/2009- UPDATED BILLING ADDRESS (WAS COMMUNITY HEALTH PHARMACY,158 BRENTWOOD DRIVE ,SUITE 7,SUITE 7,COLCHESTER,05446) 11/7/2008- ADDED MEDICAID NUMBER; 10/24/2008- ADDED BILLING ADDRESS; 3/22/06 ADD MED#; 10/11/07 UPDATED ADDRESS (WAS 53 MAIN STREET)	03/08/2012
10/6/10 CHANGE MEDICAID # (WAS 1012328); 3/4/2009- UPDATED BILLING ADDRESS (WAS COMMUNITY HEALTH PHARMACY,158 BRENTWOOD DRIVE ,SUITE 7,SUITE 7,COLCHESTER,05446) 11/7/2008- ADDED MEDICAID NUMBER; 10/24/2008- ADDED BILLING ADDRESS; 3/22/06 ADD MED#; 10/11/07 UPDATED ADDRESS (WAS 53 MAIN STREET)	10/06/2010

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
VT	0000F04,OVN0879	1750380531

Shipping Addresses

Shipping Address 1

Notch Pharmacy
44 Main Street, Suite 201
Richford, VT 05476

Shipping Address 2

Swanton Rexall
13 York Street
Swanton, VT 05488

Shipping Address 3

Fairfax Pharmacy
997 Main Street
FAIRFAX, VT 05454

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	10/20/2011	10/15/2008		03/28/2013
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/12/2018	04/01/2018		01/12/2018
Contract Detail	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #18	164 SWANTON ROAD	ST ALBANS	VT	05478	09/14/2012	10/01/2012		03/28/2013
Contract Detail	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	07/02/2024	10/01/2024		10/01/2024
Contract Detail	MARTIN'S FOODS OF SOUTH BURLINGTON, LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #83	290 HIGHGATE COMMONS ROAD	ST ALBANS	VT	05478	01/12/2021	04/01/2021		04/01/2021
Contract Detail	MAXI GREEN, INC.	RITE AID #10325	133 NORTH MAIN STREET SUITE 23	ST. ALBANS	VT	05478	02/15/2013	04/01/2013	01/31/2018	06/04/2018
Contract Detail	MAXI GREEN, INC.	RITE AID #10322	221 MAIN STREET PO BOX 308	ENOSBURG FALLS	VT	05450	02/15/2013	04/01/2013	01/31/2018	06/04/2018
Contract Detail	PRICE CHOPPER OPERATING CO OF VERMONT IN	PRICE CHOPPER PHARMACY 127	170 SWANTON ROAD PO BOX 434	ST ALBANS	VT	05478	04/13/2022	07/01/2022		07/01/2022
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/12/2018	04/01/2018	10/01/2022	01/20/2023
Contract Detail	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	10/20/2011	06/01/2003		03/28/2013
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/24/2017	10/01/2017		10/01/2017
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/24/2017	10/01/2017		10/01/2017
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19795	133 N MAIN ST SUITE 23	SAINT ALBANS	VT	05478-1735	02/12/2018	02/13/2018		02/13/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #19346	221 MAIN ST	ENOSBURG FALLS	VT	05450	02/12/2018	02/13/2018		02/13/2018
Contract Detail	WALGREEN EASTERN CO., INC.	WALGREENS #17747	201 US ROUTE 7 SOUTH	MILTON	VT	05468	07/03/2018	10/01/2018		10/01/2018
Contract Detail	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	07/11/2023	10/01/2023		10/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/12/2018	04/01/2018	10/01/2021	10/01/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/12/2018	04/01/2018		01/12/2018
Contract Detail	WALMART PHARMACY 10-2332	700 TUCKERS WAY		SAINT ALBANS	VT	05478	10/05/2016	01/01/2017		10/05/2016
Contract Detail	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/04/2023	01/01/2024		01/01/2024
Contract Detail	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	10/04/2023	01/01/2024		01/01/2024

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH013970	Active	BPS-H80-004635	RICHFORD HEALTH CENTER, INC.	Richford Health Center	44 Main Street	Richford	VT
CH01397A	Active	BPS-H80-010140	RICHFORD HEALTH CENTER, INC.	ENOSBURG HEALTH CENTER	382 Main Street	Enosburg Falls	VT
CH01397B	Active	BPS-H80-006154	RICHFORD HEALTH CENTER, INC.	ALBURG HEALTH CENTER	64 INDUSTRIAL PARK RD	ALBURG	VT
CH01397C	Active	BPS-H80-017476	RICHFORD HEALTH CENTER, INC.	SWANTON HEALTH CENTER	26 Canada St	Swanton	VT
CH01397D	Active	BPS-H80-027326	RICHFORD HEALTH CENTER, INC.	St Albans Health Center	3 Crest Rd	Saint Albans	VT
CH01397E	Terminated	BPS-H80-013570	RICHFORD HEALTH CENTER, INC.	NCSS Health Center	107 Fisher Pond Rd	Saint Albans	VT
CH01397F	Active	BPS-H80-008444	RICHFORD HEALTH CENTER, INC.	Richford Dental Clinic	44 Main St STE 400	Richford	VT
CH01397G	Terminated	BPS-H80-009487	RICHFORD HEALTH CENTER, INC.	NOTCH Dental Clinic	100 Thunderbird Drive BLDG Dental	Swanton	VT
CH01397H	Terminated	BPS-H80-017251	RICHFORD HEALTH CENTER, INC.	Fairfield Street Health Center	77 Fairfield Street	Saint Albans	VT
CH01397J	Active	BPS-H80-020867	RICHFORD HEALTH CENTER, INC.	Fairfax Health Center	1199 Main St	Fairfax	VT
CH01397K	Active	BPS-H80-034322	RICHFORD HEALTH CENTER, INC.	Georgia Health Center	4178 Highbridge Rd	Fairfax	VT
CH01397L	Active	BPS-H80-034323	RICHFORD HEALTH CENTER, INC.	NOTCH Primary Care	12 Crest Rd	Saint Albans	VT

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH013970	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	10/15/2008
CH01397C	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	10/15/2008
CH01397B	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	10/15/2008
CH01397A	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	10/15/2008
CH01397D	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	10/15/2008
CH01397E	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	07/01/2014	04/01/2019
CH01397G	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	07/01/2014	01/01/2017
CH01397H	COMMUNITY HEALTH PHARMACY	158 BRENTWOOD DR STE 6		COLCHESTER	VT	05446-7994	04/01/2016	04/01/2019
CH013970	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	04/01/2018
CH013970	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #18	164 SWANTON ROAD	ST ALBANS	VT	05478	10/01/2012
CH01397E	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #18	164 SWANTON ROAD	ST ALBANS	VT	05478	07/01/2014	04/01/2019
CH01397H	KPH HEALTHCARE SERVICES, INC.	KINNEY DRUGS #18	164 SWANTON ROAD	ST ALBANS	VT	05478	04/01/2016	04/01/2019
CH013970	KPH HEALTHCARE SERVICES, INC.	DBA: KINNEY DRUGS CF	471 E MAIN ST UNIT 5	GOUVERNEUR	NY	13642	10/01/2024
CH013970	MARTIN'S FOODS OF SOUTH BURLINGTON, LLC	DBA HANNAFORD SUPERMARKET & PHARMACY #83	290 HIGHGATE COMMONS ROAD	ST ALBANS	VT	05478	04/01/2021
CH013970	MAXI GREEN, INC.	RITE AID #10325	133 NORTH MAIN STREET SUITE 23	ST. ALBANS	VT	05478	04/01/2013	01/31/2018
CH013970	MAXI GREEN, INC.	RITE AID #10322	221 MAIN STREET PO BOX 308	ENOSBURG FALLS	VT	05450	04/01/2013	01/31/2018
CH01397E	MAXI GREEN, INC.	RITE AID #10325	133 NORTH MAIN STREET SUITE 23	ST. ALBANS	VT	05478	07/01/2014	04/01/2019
CH01397E	MAXI GREEN, INC.	RITE AID #10322	221 MAIN STREET PO BOX 308	ENOSBURG FALLS	VT	05450	07/01/2014	04/01/2019
CH01397G	MAXI GREEN, INC.	RITE AID #10322	221 MAIN STREET PO BOX 308	ENOSBURG FALLS	VT	05450	07/01/2014	01/01/2017
CH01397G	MAXI GREEN, INC.	RITE AID #10325	133 NORTH MAIN STREET SUITE 23	ST. ALBANS	VT	05478	07/01/2014	01/01/2017
CH01397H	MAXI GREEN, INC.	RITE AID #10325	133 NORTH MAIN STREET SUITE 23	ST. ALBANS	VT	05478	04/01/2016	04/01/2019
CH01397H	MAXI GREEN, INC.	RITE AID #10322	221 MAIN STREET PO BOX 308	ENOSBURG FALLS	VT	05450	04/01/2016	04/01/2019
CH013970	PRICE CHOPPER OPERATING CO OF VERMONT IN	PRICE CHOPPER PHARMACY 127	170 SWANTON ROAD PO BOX 434	ST ALBANS	VT	05478	07/01/2022
CH013970	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	04/01/2018	10/01/2022
CH013970	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	06/01/2003
CH01397C	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	03/04/2009
CH01397B	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	03/04/2009
CH01397A	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	03/04/2009
CH01397D	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	03/04/2009
CH01397E	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	07/01/2014	04/01/2019
CH01397G	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	07/01/2014	01/01/2017
CH01397H	RICHFORD HEALTH CENTER INC	D/B/A NOTCH PHARMACY	44 MAIN ST STE 201	RICHFORD	VT	05476-1141	04/01/2016	04/01/2019
CH013970	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2017
CH013970	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2017
CH013970	WALGREEN EASTERN CO., INC.	WALGREENS #19795	133 N MAIN ST SUITE 23	SAINT ALBANS	VT	05478-1735	02/13/2018
CH013970	WALGREEN EASTERN CO., INC.	WALGREENS #19346	221 MAIN ST	ENOSBURG FALLS	VT	05450	02/13/2018
CH013970	WALGREEN EASTERN CO., INC.	WALGREENS #17747	201 US ROUTE 7 SOUTH	MILTON	VT	05468	10/01/2018
CH013970	Walgreens Central Fill #21400	44 Cabot Blvd.		Mansfield	MA	02048	10/01/2023
CH013970	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	04/01/2018
CH013970	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	04/01/2018
CH013970	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	04/01/2018	10/01/2021
CH013970	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	04/01/2018
CH013970	WALMART PHARMACY 10-2332	700 TUCKERS WAY		SAINT ALBANS	VT	05478	01/01/2017
CH013970	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	01/01/2024
CH013970	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/5/2024 1:40:59 PM	2/12/2025 12:22:11 PM	2/12/2025 12:22 PM
Contacts	Authorizing Official	Update	Profile Change Request	BENOIT, KATHY J FINANCE DIRECTOR Richford Health Center, Inc. 8022555562-562	BENOIT, KATHY J Executive Director Richford Health Center, Inc. 8022555562-562	2/5/2024 1:41 PM
Details	Last Recertification Date	Update	Recertification	2/3/2023 4:52:25 PM	2/5/2024 1:40:59 PM	2/5/2024 1:40 PM
Details	Last Recertification Date	Update	Recertification	2/18/2022 1:19:19 PM	2/3/2023 4:52:25 PM	2/3/2023 4:52 PM
Contacts	Authorizing Official	Update	Change Request	PARSONS, PAMELA CEO Richford Health Center, Inc. 8022555561-561	BENOIT, KATHY J FINANCE DIRECTOR Richford Health Center, Inc. 8022555562-562	12/13/2022 3:26 PM
Contacts	Primary Contact	Update	Change Request	BENOIT, KATHY J FINANCE DIRECTOR Richford Health Center, Inc. 8022555562-562	Gregoire, Darlene Executive Assistant Richford Health Center, Inc. 8022555563-563	12/13/2022 3:26 PM
Details	Last Recertification Date	Update	Recertification	2/5/2021 4:32:17 PM	2/18/2022 1:19:19 PM	2/18/2022 1:19 PM
Addresses	Shipping Address	Insert	Change Request		Fairfax Pharmacy 997 Main Street FAIRFAX, VT 05454	11/4/2021 9:31 AM
Addresses	Main Address	Update	Change Request	44 Main Street, Suite 200 Richford, VT 05476-1153	44 Main Street Richford, VT 05476-1153	7/23/2021 2:30 PM
Addresses	Shipping Address	Delete	Change Request	Swanton Rexall 44 Merchants Row Swanton, VT 05488		6/16/2021 1:01 PM
Addresses	Shipping Address	Insert	Change Request		Swanton Rexall 13 York Street Swanton, VT 05488	6/16/2021 1:01 PM
Medicaid Billing	NPI: State	Update	Recertification		VT	2/5/2021 4:32 PM
Details	Last Recertification Date	Update	Recertification	2/3/2020 2:42:29 PM	2/5/2021 4:32:17 PM	2/5/2021 4:32 PM
Details	Last Recertification Date	Update	Recertification	1/30/2019 12:09:14 PM	2/3/2020 2:42:29 PM	2/3/2020 2:42 PM
Addresses	Shipping Address	Insert	Change Request		Notch Pharmacy 44 Main Street, Suite 201 Richford, VT 05476	6/12/2019 10:54 AM
Addresses	Shipping Address	Insert	Change Request		Swanton Rexall 44 Merchants Row Swanton, VT 05488	6/12/2019 10:54 AM
Addresses	Main Address	Update	Change Request	44 Main ST Richford, VT 05476-1153	44 Main Street, Suite 200 Richford, VT 05476-1153	6/12/2019 10:54 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/10/2019 1:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		0000F04	4/10/2019 1:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VT	4/10/2019 1:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/10/2019 1:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		OVN0879	4/10/2019 1:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		VT	4/10/2019 1:04 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1750380531	4/10/2019 1:04 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1015558 (VT)		3/15/2019 10:15 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1316195969 ( )		3/15/2019 10:15 AM
Details	Last Recertification Date	Update	Recertification	2/7/2018 3:10:40 PM	1/30/2019 12:09:14 PM	1/30/2019 12:09 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1316195969	1/23/2019 4:46 PM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1011139 (VT)		6/4/2018 3:04 PM
Details	Last Recertification Date	Update	Recertification	1/31/2017 12:00:00 AM	2/7/2018 3:10:40 PM	2/7/2018 3:10 PM
Contacts	Authorizing Official	Update	New Registration	PARSONS, PAMELA CEO 8022555561	PARSONS, PAMELA CEO Richford Health Center, Inc. 8022555561-561	10/13/2017 8:53 AM
Contacts	Primary Contact	Update		BENOIT, KATHY FINANCE DIRECTOR 8022555562-562	BENOIT, KATHY J FINANCE DIRECTOR Richford Health Center, Inc. 8022555562-562	10/2/2017 3:22 PM
Contacts	Authorizing Official	Insert			PARSONS, PAMELA CEO 8022555561	7/24/2017 1:14 PM
Addresses	Main Address	Insert			44 Main ST Richford, VT 05476-1153	1/31/2017 5:08 PM
Contacts	Primary Contact	Update		BENOIT, KATHY FINANCE DIRECTOR 8022555562	BENOIT, KATHY FINANCE DIRECTOR 8022555562-562	1/31/2017 5:08 PM
Details	Last Recertification Date	Update		2/18/2016 12:00:00 AM	1/31/2017 12:00:00 AM	1/31/2017 5:08 PM
Medicaid Billing	Medicaid: Is Primary	Update		True	False	2/18/2016 2:02 PM
Details	Last Recertification Date	Update		2/3/2015 12:00:00 AM	2/18/2016 12:00:00 AM	2/18/2016 2:02 PM
Details	Last Recertification Date	Update		3/13/2014 12:00:00 AM	2/3/2015 12:00:00 AM	2/3/2015 10:52 AM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	3/13/2014 12:00:00 AM	3/13/2014 3:29 PM
Details	Entity Subname	Update			Richford Health Center	3/13/2014 3:29 PM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	2/15/2013 1:18 PM
Contacts	Primary Contact	Insert			BENOIT, KATHY FINANCE DIRECTOR 8022555562	12/28/2012 6:11 PM
Addresses	Billing Address	Insert			NOTCH PHARMACY 44 MAIN STREET, STE 201 RICHFORD, VT 05476	12/28/2012 5:54 PM
Details	Comments Public	Insert			3/8/12 - As of 1/1/2012 Carve-in Medicaid for 340B. 10/6/10 CHANGE MEDICAID # (WAS 1012328); 3/4/2009- UPDATED BILLING ADDRESS (WAS COMMUNITY HEALTH PHARMACY,158 BRENTWOOD DRIVE ,SUITE 7,SUITE 7,COLCHESTER,05446) 11/7/2008- ADDED MEDICAID NUMBER; 10/24/2008- ADDED BILLING ADDRESS; 3/22/06 ADD MED#; 10/11/07 UPDATED ADDRESS (WAS 53 MAIN STREET)	3/8/2012 12:02 PM
Details	Last Recertification Date	Insert				10/6/2010 1:32 PM
Details	Grant Number	Insert			H80CS00261	10/6/2010 1:32 PM
Details	340B ID	Insert			CH013970	10/6/2010 1:32 PM
Details	Is Authorizing Official EHB Data	Insert				10/6/2010 1:32 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/6/2010 1:32 PM
Details	Medicare Provider Number	Insert				10/6/2010 1:32 PM
Details	Entity Name	Insert			RICHFORD HEALTH CENTER, INC.	10/6/2010 1:32 PM
Details	Program Code	Insert			CH	10/6/2010 1:32 PM
Details	Entity Subname	Insert				10/6/2010 1:32 PM
Dates	Participating Approval Date	Insert			4/2/2004 12:00:00 AM	10/6/2010 1:32 PM
Details	State	Insert			Active	10/6/2010 1:32 PM
Dates	Registration Date	Insert			1/1/2003 12:00:00 AM	10/6/2010 1:32 PM
Dates	Signed By Date	Insert				10/6/2010 1:32 PM
Dates	Start Date	Insert			1/1/2003 12:00:00 AM	10/6/2010 1:32 PM
Terminations	Termination Comments	Insert				10/6/2010 1:32 PM
Terminations	Termination Date	Insert				10/6/2010 1:32 PM
Terminations	Termination Effective Date	Insert				10/6/2010 1:32 PM
Terminations	Termination Reason	Insert				10/6/2010 1:32 PM
Details	Comments Public	Insert			10/6/10 CHANGE MEDICAID # (WAS 1012328); 3/4/2009- UPDATED BILLING ADDRESS (WAS COMMUNITY HEALTH PHARMACY,158 BRENTWOOD DRIVE ,SUITE 7,SUITE 7,COLCHESTER,05446) 11/7/2008- ADDED MEDICAID NUMBER; 10/24/2008- ADDED BILLING ADDRESS; 3/22/06 ADD MED#; 10/11/07 UPDATED ADDRESS (WAS 53 MAIN STREET)	10/6/2010 1:32 PM
Medicaid Billing	Medicaid: Is Primary	Insert			True	1/1/2003 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			1011139	1/1/2003 12:00 AM
Medicaid Billing	Medicaid: State	Insert			VT	1/1/2003 12:00 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/1/2003 12:00 AM
Medicaid Billing	Medicaid: Number	Insert			1015558	1/1/2003 12:00 AM
Medicaid Billing	Medicaid: State	Insert			VT	1/1/2003 12:00 AM

340B Drug Pricing Program Database