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SWANTON REXALL
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
SWANTON REXALL
Pharmacy Address
13 YORK ST
SWANTON, VT 05488-1320
Pharmacy Comments
Contract Details
Approval Date
10/7/2019
Contract Begin Date
1/1/2020
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
Richford Health Center, Inc.
KATHY J BENOIT, Executive Director
(802) 255-5562 Ext: 562
Signed By Date
10/7/2019
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