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MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
CAH471307-00 Porter Hospital
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Covered Entity Details
Entity Name
Porter Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471307-00
Entity Address
115 PORTER DRIVE
MIDDLEBURY, VT 05753
Medicare Provider Number
471307
Participating Start Date
9/27/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #81
260 COURT ST, UNIT 6
MIDDLEBURY, VT 05753
Pharmacy Comments
Contract Details
Approval Date
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Beinhaur, CNO
(802) 388-5637
Contract Pharmacy Representative
Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044
Signed By Date
10/9/2019
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