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WAL-MART PHARMACY 10-2681
CH010640 NORTHERN COUNTIES HEALTH CARE, INC
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Covered Entity Details
Entity Name
NORTHERN COUNTIES HEALTH CARE, INC
Subdivision Name
NORTHERN COUNTIES HEALTH CARE, INC.
Type
HRSA-Funded Health Center
340B ID
CH010640
Entity Address
165 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
WAL-MART PHARMACY 10-2681
Pharmacy Address
615 MEADOW STREET
LITTLETON, NH 03561
Pharmacy Comments
Contract Details
Approval Date
1/9/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Flood, CEO
(802) 748-9405 Ext: 1519
Contract Pharmacy Representative
Wal-Mart
Marcus Osborne, V.P. Health & Wellness, Sales & Contracting
(479) 204-9374
Signed By Date
1/9/2014
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