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BEAUCHAMP & O'ROURKE PHARMACY
SCH470005-00 RUTLAND REGIONAL MEDICAL CENTER
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Covered Entity Details
Entity Name
RUTLAND REGIONAL MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH470005-00
Entity Address
160 ALLEN STREET
RUTLAND, VT 05701
Medicare Provider Number
470005
Participating Start Date
9/30/2010
Last Recertification Date
8/24/2015
Entity Termination Date
7/1/2016
Pharmacy Details
Pharmacy Name
BEAUCHAMP & O'ROURKE PHARMACY
Pharmacy Address
62 WOODSTOCK AVE STE 1
RUTLAND, VT 05701-3534
Pharmacy Comments
Contract Details
Approval Date
7/12/2011
Contract Begin Date
7/12/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/13/2011
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