Contract Pharmacy Details

MAXI GREEN, INC.
CHC10611-04 Lamoille Health Partners, Inc.

Covered Entity Details

Entity Name

Lamoille Health Partners, Inc.

Subdivision Name

Lamoille Health Family Medicine, Stowe

Type

HRSA-Funded Health Center

340B ID

CHC10611-04

Entity Address

1878 MOUNTAIN ROAD, STE 3
STOWE, VT 05672

Grant Number

H80CS10611

Participating Start Date

4/1/2008

Last Recertification Date

2/18/2025

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

11/2/2012

Contract Begin Date

11/2/2012

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2018
Ownership change

Contacts

Covered Entity Signing Official

David Brace, Chief Financial Officer
(802) 851-8602

Contract Pharmacy Representative

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

Signed By Date

9/28/2012

340B Drug Pricing Program Database