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WAL-MART PHARMACY 10-2224
CH010150 COMMUNITY HEALTH CENTERS OF BURLINGTON, INC.
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Covered Entity Details
Entity Name
COMMUNITY HEALTH CENTERS OF BURLINGTON, INC.
Subdivision Name
Riverside Health Center
Type
HRSA-Funded Health Center
340B ID
CH010150
Entity Address
617 Riverside Ave
Burlington, VT 05401-1601
Grant Number
H80CS00311
Participating Start Date
7/1/1995
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2224
Pharmacy Address
863 HARVEST LANE
WILLISTON, VT 05495
Pharmacy Comments
Contract Details
Approval Date
8/17/2012
Contract Begin Date
8/17/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jack Donnelly, CEO
(802) 864-6309
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
7/25/2012
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