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MARBLE WORKS PHARMACY
CHC26642-00 FIVE-TOWN HEALTH ALLIANCE, INC.
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Covered Entity Details
Entity Name
FIVE-TOWN HEALTH ALLIANCE, INC.
Subdivision Name
Mountain Community Health
Type
HRSA-Funded Health Center
340B ID
CHC26642-00
Entity Address
61 Pine St Bldg 4
BRISTOL, VT 05443
Grant Number
H80CS26642
Participating Start Date
1/1/2014
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
MARBLE WORKS PHARMACY
Pharmacy Address
PHARMACY HEALTH SERVICES
99 MAPLE STREET
MIDDLEBURY, VT 05753
Pharmacy Comments
Contract Details
Approval Date
1/13/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2017
Ownership change
Contacts
Covered Entity Signing Official
Martha A. Halnon, CEO
(802) 453-5116
Contract Pharmacy Representative
PHSRX
Catherine Friend, Pharmacy Manager
(802) 388-3874
Signed By Date
1/13/2014
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