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THE GOLUB CORPORATION
DSH470005 RUTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RUTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH470005
Entity Address
160 ALLEN STREET
RUTLAND, VT 05701
Medicare Provider Number
470005
Participating Start Date
7/1/2016
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
THE GOLUB CORPORATION
Pharmacy Address
DBA PRICE CHOPPER PHARMACY #131
234 RUTLAND SHOPPING PLAZA
RUTLAND, VT 05701
Pharmacy Comments
Contract Details
Approval Date
10/16/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Judi K Fox, CFO
(802) 747-1632
Contract Pharmacy Representative
Golub Corporation
Kathleen Bryant, Vice President of Pharmacy
(518) 379-1122
Signed By Date
10/16/2019
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