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MAXI GREEN, INC.
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
MAXI GREEN, INC.
Pharmacy Address
RITE AID #10320
1 PRINCE LANE
BRISTOL, VT 05443
Pharmacy Comments
Contract Details
Approval Date
1/15/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2018
Ownership change
Contacts
Covered Entity Signing Official
Martha A. Halnon, CEO
(802) 453-5116
Contract Pharmacy Representative
Rite Aid
Tammy Royer, Group Vice President, Managed Care
(717) 730-8217
Signed By Date
1/15/2014
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