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SOUTH HERO PHARMACY LLC
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
SOUTH HERO PHARMACY LLC
Pharmacy Address
334 ROUTE 2
SOUTH HERO, VT 05486-4229
Pharmacy Comments
Contract Details
Approval Date
1/12/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/26/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Jack Donnelly, CEO
(802) 864-6309
Contract Pharmacy Representative
Riyaz Merali, Owner
(802) 372-5377
Signed By Date
1/12/2015
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