Contract Pharmacy Details

MAXI GREEN, INC.
CHC11353-01 SPRINGFIELD MEDICAL CARE SYSTEMS INC

Covered Entity Details

Entity Name

SPRINGFIELD MEDICAL CARE SYSTEMS INC

Subdivision Name

The Women's Health Center of Springfield

Type

HRSA-Funded Health Center

340B ID

CHC11353-01

Entity Address

29 Ridgewood Rd. FL A
Springfield, VT 05156-3050

Grant Number

H80CS12873

Participating Start Date

1/1/2010

Last Recertification Date

1/30/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

MAXI GREEN, INC.

Pharmacy Address

RITE AID #10313
55 SPRINGFIELD PLAZA RD
SPRINGFIELD, VT 05156-2911

Pharmacy Comments

Contract Details

Approval Date

9/26/2012

Contract Begin Date

9/26/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Scott Whittemore, Chief Financial Officer
(802) 885-7344

Contract Pharmacy Representative

Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217

Signed By Date

8/29/2012

340B Drug Pricing Program Database