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RITE AID OF VERMONT, INC.
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
RITE AID OF VERMONT, INC.
Pharmacy Address
RITE AID #1363
4993 MAIN STREET SUITE A
MANCHESTER CENTER, VT 05255
Pharmacy Comments
Contract Details
Approval Date
3/1/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Covered Entity Terminated
Contacts
Covered Entity Signing Official
THOMAS HUEBNER, CEO
(802) 747-1600
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/2/2013
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