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WALGREEN EASTERN CO., INC.
SCH470001-00 Central Vermont Medical Center
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Covered Entity Details
Entity Name
Central Vermont Medical Center
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH470001-00
Entity Address
130 FISHER ROAD
BERLIN, VT 05602
Medicare Provider Number
470001
Participating Start Date
9/30/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #17625
412 BROAD ST
LYNDONVILLE, VT 05851
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Choate, Vice President Patient Care Services / CNO
(802) 371-4354
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/15/2019
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