Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
SCH470024-00 Northwestern Medical Center, Inc.

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

WALGREEN EASTERN CO., INC.

Pharmacy Address

DBA: WALGREENS #11526
514 FARRELL ST.
BURLINGTON, VT 05401-6907

Pharmacy Comments

Contract Details

Approval Date

1/7/2022

Contract Begin Date

1/27/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/19/2025
Pharmacy closed

Contacts

Covered Entity Signing Official

Deanna Orfanidis, Chief Nursing Officer
(802) 524-1068

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/7/2022

340B Drug Pricing Program Database