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MAXI GREEN, INC.
CH01064I NORTHERN COUNTIES HEALTH CARE, INC
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Covered Entity Details
Entity Name
NORTHERN COUNTIES HEALTH CARE, INC
Subdivision Name
ST. JOHNSBURY COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH01064I
Entity Address
185 Sherman Dr
Saint Johnsbury, VT 05819-9811
Grant Number
H80CS00632
Participating Start Date
9/1/2008
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
MAXI GREEN, INC.
Pharmacy Address
RITE AID #10330
48 CONGRESS STREET
PO BOX 731
MORRISVILLE, VT 05661
Pharmacy Comments
Contract Details
Approval Date
9/12/2012
Contract Begin Date
9/12/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2018
Ownership change
Contacts
Covered Entity Signing Official
Thomas Pitts, CFO
(802) 748-9405 Ext: 1599
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
8/30/2012
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