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WALGREEN EASTERN CO., INC.
RRC470012-00 SOUTHWESTERN VERMONT MEDICAL CENTER
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Covered Entity Details
Entity Name
SOUTHWESTERN VERMONT MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC470012-00
Entity Address
100 HOSPITAL DR
BENNINGTON, VT 05201
Medicare Provider Number
470012
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #17717
116 QUAKER ST
GRANVILLE, NY 12832
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen D. Majetich, CFO
(802) 447-5011
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/17/2022
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