Contract Pharmacy Details

WILCOX PHARMACY
CAH471307-00 Porter Hospital

Covered Entity Details

Entity Name

Porter Hospital

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH471307-00

Entity Address

115 PORTER DRIVE
MIDDLEBURY, VT 05753

Medicare Provider Number

471307

Participating Start Date

9/27/2010

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

WILCOX PHARMACY

Pharmacy Address

252 STRATTON ROAD
RUTLAND, VT 05701

Pharmacy Comments

Contract Details

Approval Date

4/6/2015

Contract Begin Date

4/14/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/9/2017
Ownership change

Contacts

Covered Entity Signing Official

JAMES DAILY, CEO
(802) 388-4741

Contract Pharmacy Representative

RIchard Wilcox, President
(802) 775-3351

Signed By Date

4/6/2015