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MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
CH021790 HUDSON HEADWATERS HEALTH NETWORK
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Covered Entity Details
Entity Name
HUDSON HEADWATERS HEALTH NETWORK
Subdivision Name
Hudson Headwaters Administrative Offices
Type
HRSA-Funded Health Center
340B ID
CH021790
Entity Address
9 CAREY ROAD
QUEENSBURY, NY 12804
Grant Number
H80CS00159
Participating Start Date
4/1/2001
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #83
3758 BURGOYNE AVENUE
HUDSON FALLS, NY 12839
Pharmacy Comments
Contract Details
Approval Date
1/4/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
James T Donnelly, EVP of 340B Pharmacy Services
(518) 824-2340
Contract Pharmacy Representative
John McGrath, Vice President, Pharmacy
(207) 885-2348
Signed By Date
1/4/2017
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