340B Drug Pricing Program Database

Pharmacy Name

LAKESIDE PHARMACY INC

Pharmacy Address

242 PEARL ST
BURLINGTON, VT 05401

Pharmacy Comments

Approval Date

8/1/2012

Contract Begin Date

8/1/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/31/2018
Pharmacy closed

Covered Entity Signing Official

Roger Deshaies, CFO
(802) 847-9975

Contract Pharmacy Representative

Earl Pease, President/Treasurer
(802) 862-1491

Signed By Date

6/26/2012