Contract Pharmacy Details

MAXI GREEN, INC.
CH0112230 COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION

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 #10334
263 COURT STREET
MIDDLEBURY, VT 05753

Pharmacy Comments

Contract Details

Approval Date

10/18/2016

Contract Begin Date

1/1/2017

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
Alison Farrell, Vice President |Managed Care
(717) 975-5968

Signed By Date

10/18/2016

340B Drug Pricing Program Database