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NORTHFIELD PHARMACY INC
CAH471301-00 GIFFORD MEDICAL CENTER
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Covered Entity Details
Entity Name
GIFFORD MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH471301-00
Entity Address
44 SOUTH MAIN STREET
RANDOLPH, VT 05060
Medicare Provider Number
471301
Participating Start Date
7/1/2011
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
NORTHFIELD PHARMACY INC
Pharmacy Address
NORTHFIELD PHARMACY
14 DEPOT SQ
NORTHFIELD, VT 05663-6958
Pharmacy Comments
Contract Details
Approval Date
11/10/2011
Contract Begin Date
11/10/2011
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/18/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JOSEPH WOODIN, PRESIDENT
(802) 728-2304
Contract Pharmacy Representative
Kristin Brewer, Pharmacist
(802) 485-4771
Signed By Date
10/7/2011
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