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WALGREEN EASTERN CO., INC.
SCH470024-00 Northwestern Medical Center, Inc.
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Covered Entity Details
Entity Name
Northwestern Medical Center, Inc.
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH470024-00
Entity Address
133 Fairfield Street
St. Albans, VT 05478
Medicare Provider Number
470024
Participating Start Date
1/1/2012
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19346
221 MAIN ST
ENOSBURG FALLS, VT 05450
Pharmacy Comments
Contract Details
Approval Date
4/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Joel Patrick Benware, Chief Information, Innovation and Compliance Officer
(802) 524-1212
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/2/2019
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