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WALGREEN EASTERN CO., INC.
CAH471307-00 Porter Hospital
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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
WALGREEN EASTERN CO., INC.
Pharmacy Address
DBA: WALGREENS # 01756
10 WOODSTOCK AVE
RUTLAND, VT 05701-3514
Pharmacy Comments
Contract Details
Approval Date
4/13/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Karen Beinhaur, CNO
(802) 388-5637
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/13/2017
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