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

7/7/2017

Contract Begin Date

7/10/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/20/2020
Pharmacy closed

Contacts

Covered Entity Signing Official

Karen Beinhaur, CNO
(802) 388-5637

Contract Pharmacy Representative

Steve Bower, VP
(864) 504-0017

Signed By Date

7/7/2017