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MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
CAH471301-00 GIFFORD MEDICAL CENTER
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Covered Entity Details
Entity Name
GIFFORD MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471301-00
Entity Address
44 SOUTH MAIN STREET
RANDOLPH, VT 05060
Medicare Provider Number
471301
Participating Start Date
7/1/2011
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
MARTIN'S FOODS OF SOUTH BURLINGTON, LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #81
456 S. BARRE RD
BARRE, VT 05641
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Bennett, CEO
(802) 728-2304
Contract Pharmacy Representative
Hannaford Supermarket and Pharmacy
Daniel Montagnola, Business Development Manager
(315) 427-5178
Signed By Date
1/16/2024
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