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PRICE CHOPPER OPERATING CO OF VERMONT IN
SCH470024-00 Northwestern Medical Center, Inc.
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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
PRICE CHOPPER OPERATING CO OF VERMONT IN
Pharmacy Address
PRICE CHOPPER PHARMACY 127
170 SWANTON ROAD
PO BOX 434
ST ALBANS, VT 05478
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephanie Alicia Breault, CFO
(802) 524-8823
Contract Pharmacy Representative
Northeast Shared Services
Scott Guisinger, Vice President of Pharmacy
(518) 379-2409
Signed By Date
4/11/2023
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