Contract Pharmacy Details

MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
RRC330023-00 VASSAR BROTHERS MEDICAL CENTER

Covered Entity Details

Entity Name

VASSAR BROTHERS MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC330023-00

Entity Address

45 READE PLACE
POUGHKEEPSIE, NY 12601

Medicare Provider Number

330023

Participating Start Date

3/1/2022

Last Recertification Date

8/16/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

MARTIN'S FOODS OF SOUTH BURLINGTON, LLC

Pharmacy Address

DBA HANNAFORD SUPERMARKET & PHARMACY #83
3650 ROUTE 9W
HIGHLAND, NY 12528

Pharmacy Comments

Contract Details

Approval Date

7/12/2022

Contract Begin Date

7/27/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/23/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Karen M Steele, VP of Pharmacy Services
(845) 472-9571

Contract Pharmacy Representative

Hannaford
Mike Fish, Pharmacy District Manager
(518) 428-2712

Signed By Date

7/12/2022

340B Drug Pricing Program Database