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MAXI GREEN, INC.
CH0112230 COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION
Subdivision Name
CHC'S OF RUTLAND REGION, INC.
Type
HRSA-Funded Health Center
340B ID
CH0112230
Entity Address
275 Route 30 N
Bomoseen, VT 05732-9647
Grant Number
H80CS06659
Participating Start Date
7/1/2006
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
MAXI GREEN, INC.
Pharmacy Address
RITE AID #10333
1 UNION STREET
BRANDON, VT 05733
Pharmacy Comments
03/01/2013 adress line 1 update (was 1 CARVER STREET)
Contract Details
Approval Date
10/19/2012
Contract Begin Date
10/19/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2018
Ownership change
Contacts
Covered Entity Signing Official
GRANT WHITMER, EXECUTIVE DIRECTOR
(802) 855-2081
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
9/7/2012
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